Background and ObjectivesThe goal of this work was to compare clinical characteristics across immunopathologic subtypes of patients with multiple sclerosis.MethodsImmunopathologic subtyping was performed on specimens from 547 patients with biopsy- or autopsy-confirmed CNS demyelination.ResultsThe frequency of immunopathologic subtypes was 23% for pattern I, 56% for pattern II, and 22% for pattern III. Immunopatterns were similar in terms of age at autopsy/biopsy median age 41 years, range 4-83 years, p = 0.16 and proportion female 54%, p = 0.71. Median follow-up after symptom onset was 2.3 years range 0-38 years. In addition to being overrepresented among autopsy cases 45% vs 19% in biopsy cohort, p < 0.001, index attack-related disability was higher in pattern III vs II median Expanded Disability Status Scale score 4 vs 3, p = 0.02. Monophasic clinical course was more common in patients with pattern III than pattern I or II 59% vs 33% vs 32%, p < 0.001. Similarly, patients with pattern III pathology were likely to have progressive disease compared to patients with patterns I or II when followed up for ≥5 years 24% overall, p = 0.49, with no differences in long-term survival, despite a more fulminant attack presentation.ConclusionAll 3 immunopatterns can be detected in active lesions, although they are found less frequently later into the disease due to the lower number of active lesions. Pattern III is associated with a more fulminant initial attack than either pattern I or II. Biopsied patients appear to have similar long-term outcomes regardless of their immunopatterns. Progressive disease is less associated with the initial immunopattern and suggests convergence into a final common pathway related to the chronically denuded axon.
ASJC Scopus subject areas
- Clinical Neurology