Multiple sclerosis (MS) is a common, chronic neurological disease with a highly variable prognosis and clinical course. There is a pressing need for reliable predictors of future disease course not only for individual patient counseling, but also because there are now disease-modifying treatments that favorably modify the early relapsing-remitting phase of the disease. And it is desirable to know for whom such treatments are most needed and useful.
Magnetic resonance imaging (MRI) provides useful prognostic information in relapse-onset MS. In patients presenting with a clinically isolated syndrome suggesting demyelination, the presence of clinically silent MRI lesions that are characteristic for demyelination is highly predictive of future relapse, leading to a diagnosis of clinically definite MS, and MRI lesion features are now included in criteria that enable an earlier diagnosis of MS.1 Furthermore, the presence of active lesions on serial MRI in relapsing-remitting MS is associated with higher clinical relapse risk and a strong group-level correlation is observed between treatment-associated decreases in relapses and active lesions in controlled clinical trials.2
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