Tsantes Elena, Leone Maurizio A, Curti Erica, Cantello Roberto, Vecchio Domizia, Granella Franco
Neurosciences Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
Neurology Unit, Department of Medical Sciences, Fondazione IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy; Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), Novara, Italy.
J Clin Neurosci. 2020 Apr;74:175-179. doi: 10.1016/j.jocn.2020.02.017. Epub 2020 Feb 24.
Predictors of attack location in relapsing-remitting multiple sclerosis (RRMS) are poorly known. It has been suggested that the site of the first relapse may influence the location of the subsequents. We aimed to ascertain this hypothesis in a sample of patients consecutively recruited in two Italian MS Centres, with at least two MS attacks. The following data were collected from medical records: demographic data, locations involved in the first two (or three) MS attacks (optic nerve, spinal cord, brain stem/cerebellum, cerebral hemispheres, according to symptoms presented), time elapsed between relapses and onset of disease-modifying treatment (DMT). We enrolled 199 patients (67% females; MS onset age 30.0 ± 8.69 years), in 148 of whom we could define the precise attack location. In 70/148 patients (47%) the second attack involved exactly the same location as the first. There was an increased risk of relapsing in the same location of the first attack when this involved the optic nerve (OR 4.5, 95% CI 2.2-9.2, p < 0.0001), the brainstem/cerebellum (OR 3.5, 95% CI 1.7-6.9, p < 0.0001), or the spinal cord (OR 3.0, 95% CI 1.5-5.9, p = 0.001). The location of third relapse (N = 90) was equally influenced by the site of first attack. In 24 patients with optic neuritis in both the two first attacks, the side coincided in 50% of cases. The location of first attack has a major role in influencing the site of subsequent ones in RRMS.
复发缓解型多发性硬化症（RRMS）发作部位的预测因素鲜为人知。有人提出首次复发的部位可能会影响后续复发的位置。我们旨在对意大利两个多发性硬化症中心连续招募的至少有两次MS发作的患者样本进行验证这一假设。从病历中收集了以下数据：人口统计学数据、前两次（或三次）MS发作所累及的部位（根据出现的症状分为视神经、脊髓、脑干/小脑、大脑半球）、复发与开始疾病修正治疗（DMT）之间的时间间隔。我们纳入了199例患者（67%为女性；MS发病年龄30.0±8.69岁），其中148例患者我们能够确定确切的发作部位。在148例患者中的70例（47%）中，第二次发作累及的部位与第一次完全相同。当首次发作累及视神经时（比值比4.5，95%置信区间2.2 - 9.2，p < 0.0001）、脑干/小脑时（比值比3.5，95%置信区间1.7 - 6.9，p < 0.0001）或脊髓时（比值比3.0，95%置信区间1.5 - 5.9，p = 0.001），在首次发作的相同部位复发的风险增加。第三次复发（n = 90）的部位同样受到首次发作部位的影响。在两次首次发作均为视神经炎的24例患者中，50%的病例两侧一致。在RRMS中，首次发作的部位对影响后续发作的部位起主要作用。
