Aggressive multiple sclerosis in Argentina: Data from the nationwide registry RelevarEM.

The objectives of the present study were to describe the frequency of aggressive multiple sclerosis (aMS) as well as to compare clinical and radiological characteristics in aMS and non-aMS patients included in RelevarEM (NCT03375177). METHODS: The eligible study population and cohort selection included adult-onset patients (≥18 years) with definite MS. AMS were defined as those reaching confirmed EDSS ≥ 6 within 5 years from symptom onset. Confirmation was achieved when a subsequent EDSS ≥ 6 was recorded at least six months later but within 5 years of the first clinical presentation. AMS and non-aMS were compared using the χ2 test for categorical and the Mann-Whitney for continuous variables at MS onset and multivariable analysis was performed using forward stepwise logistic regression with baseline characteristics at disease onset. RESULTS: A total of 2158 patients with MS were included: 74 aMS and 2084 non-aMS. The prevalence of aMS in our cohort was 3.4% (95%CI 2.7-4.2). AMS were more likely to be male (p = 0.003), older at MS onset (p < 0.001), have primary progressive MS (PPMS) phenotype (p = 0.03), multifocal presentation (p < 0.001), and spinal cord as well as infratentorial lesions at MRI during disease onset (p = 0.004 and p = 0.002, respectively). CONCLUSION: 3.4% of our patient population could be considered aMS. Men, patients older at symptom onset, multifocal presentation, PPMS phenotype, and spinal cord as well as brainstem lesions on MRI at clinical presentation all had higher odds of having aMS.

Decision-making on radiologically isolated syndrome among Argentinean neurologists: A survey based on clinical experience.

BACKGROUND: Although management of radiologically isolated syndrome (RIS) is still a challenge in clinical practice, in the absence of evidence-based guidelines, the report of survey results might give neurologists some guidance to optimize clinical decision-making. Our aim was to investigate the current RIS management approach of Argentinean neurologists based on their clinical experience. METHODS: An anonymous voluntary cross-sectional web-based survey was performed by Argentinean neurologists. We developed questions based on a hypothetical patient with RIS. General agreement was defined as at least 75% of concordance in the answer to each particular question. RESULTS: Sixty-six out of 91 (72%) neurologists completed the survey. There was general agreement on following up patients, performing further examinations and not treating RIS patients at presentation. In addition, participants agreed to perform a lumbar puncture to evaluate the presence of oligoclonal bands (OCB, 82%) and to order a spinal cord MRI (75.4%). During follow-up, there was agreement to perform brain (100%) and spinal (80%) MRI. A few participants would prescribe treatment to RIS patients with both Gd-negative and Gd-positive lesions on spinal MRI. In addition, if a brain Gd-positive lesion is observed at onset, 43.6% would prescribe treatment. During the follow-up, only 15.4% would initiate treatment in the absence of clinical symptoms, regardless of the examinations' results. In those cases in which a treatment was prescribed, there was agreement in using injectable drugs (78.7%). CONCLUSION: These findings give us a first idea about Argentinean neurologists' decision-making on this entity and may help in the development of a practice guideline.