Wednesday, April 29April 14, 2020Free AccessMRI Changes Over the Disease Course in a Large Multiple Sclerosis Clinical Cohort (2221)Gabrielle Macaron, Kunio Nakamura, Kedar Mahajan, Ryan Honomischl, Scott Husak, Nicolas Thompson, Robert Bermel, Jeffrey Cohen, and Daniel OntanedaAuthors Info & AffiliationsApril 14, 2020 issue94 (15_supplement)https://doi.org/10.1212/WNL.94.15_supplement.2221 Letters to the Editor

Background and purposeTo analyze the relationship between cognitive processing speed, patient‐reported outcome measures (PROMs), employment and magnetic resonance imaging (MRI) metrics in a large multiple sclerosis cohort.MethodsCross‐sectional clinical data, PROMs, employment and MRI studies within 90 days of completion of the Processing Speed Test (PST), a technology‐enabled adaptation of the Symbol Digit Modalities Test, were collected. MRI was analyzed using semi‐automated methods. Correlations of PST score with PROMs and MRI metrics were examined using Spearman’s rho. Wilcoxon rank sum testing compared MRI metrics across PST score quartiles and linear regression models identified predictors of PST performance. Effects of employment and depression were also investigated.ResultsIn 721 patients (mean age 47.6 ± 11.4 years), PST scores were significantly correlated with all MRI metrics, including cord atrophy and deep gray matter volumes. Linear regression demonstrated self‐reported physical disability, cognitive function, fatigue and social domains (adjusted R2 = 0.44, P < 0.001) as the strongest clinical predictors of PST score, whereas that of MRI variables included T2 lesion volume, whole‐brain fraction and cord atrophy (adjusted R2 = 0.42, P < 0.001). An inclusive model identified T2 lesion volume, whole‐brain fraction, self‐reported upper extremity function, cognition and social participation as the strongest predictors of PST score (adjusted R2 = 0.51, P < 0.001). There was significant effect modification by depression on the relationship between self‐reported cognition and PST performance. Employment status was associated with PST scores independent of age and physical disability.ConclusionThe PST score correlates with PROMs, MRI measures of focal and diffuse brain injury, and employment. The PST score is a feasible and meaningful measure for routine multiple sclerosis care.

Background: Severe residual visual loss (SRVL) is frequent in neuromyelitis optica spectrum disorders (NMOSD). Identifying higher-risk patients at onset is important to prevent disability accumulation. Objective: To determine predictors of SRVL in a large NMOSD cohort. Methods: Patient characteristics at last visual acuity (VA) evaluation were retrospectively collected. VA was scored 0: better than 20/40, 1: 20/40-20/99, 2: 20/100-20/200, and 3: worse than 20/200. SRVL was defined as a combined score (VA worst + best eye) > 4. Descriptive statistics were used to compare groups and logistic regression to evaluate predictors of VA. Results: 106 patients (mean age at disease onset (AO): 35.8 +/- 16.5 years) were included. Patients with SRVL had earlier AO (mean: 26.7 vs 38.0 years) compared to non-SRVL group (p = 0.005). Patients with AO < 21 years were more likely to have SRVL, be blind, present with binocular optic neuritis, have recurrent optic neuritis, and receive oral therapy first-line than those with AO > 21. After adjusting for race, sex, and disease duration, the odds of SRVL were 4.68 times higher in patients < 21 at disease onset (95% CI: 1.53-14.34, p = 0.007). Conclusion: Early AO predicts SRVL in NMOSD, independent of disease duration. High-efficacy therapies should be considered for first-line treatment in this group.