Ozakbas S, Mammadov O, Alizada S
… +3 more, Samadzade U, Caliskan C, Simsek Y
Mult Scler Relat Disord
· 2026 Jun · PMID 41985260
·
Publisher ↗
BACKGROUND: Natalizumab is a highly effective therapy for relapsing multiple sclerosis (MS), yet few real-world studies have directly compared disease activity before and after treatment initiation within the same patien...BACKGROUND: Natalizumab is a highly effective therapy for relapsing multiple sclerosis (MS), yet few real-world studies have directly compared disease activity before and after treatment initiation within the same patients. OBJECTIVE: To evaluate the real-world impact of natalizumab on relapse activity, disability, and MRI activity by comparing disease outcomes during the three years before and after treatment initiation. METHODS: We retrospectively analyzed 246 patients who initiated natalizumab at a single centre. After excluding patients without baseline data (n = 38) or with insufficient follow-up or incomplete MRI data (n = 77), 131 patients were included in the final analysis. Annualized relapse rate (ARR), Expanded Disability Status Scale (EDSS), and MRI activity were compared between the 36-month pre-treatment and 36-month on-treatment periods. RESULTS: Natalizumab treatment was associated with a marked reduction in relapse activity. Mean ARR decreased from 0.69 in the pre-treatment period to 0.04 during the on-treatment period, and the proportion of patients with relapses declined from 88.5% to 8.4%. Disability remained overall stable during follow-up, with no significant difference between EDSS three years before treatment and EDSS three years after treatment. MRI activity decreased from 74.8% in the pre-treatment period to 9.2% during the on-treatment period, and 84.0% of patients achieved no evidence of disease activity (NEDA-3). Pregnancy-related observations were limited to a small descriptive subgroup. CONCLUSION: Over three years, natalizumab was associated with substantial suppression of relapse activity, stable disability, and reduced MRI activity compared with the pre-treatment period.
Apóstolos-Pereira SL, Terrim S, Santana de Araujo R
… +11 more, Simon Nogueira AB, Macedo de Souza Tieppo E, Aguiar Santos Faria G, Baleeiro Rodrigues Silva P, Vieira Marques Filho F, Santillan T, Rosalem R, Holanda A, Silva GD, Adoni T, Callegaro D
Mult Scler Relat Disord
· 2026 Jun · PMID 41965135
·
Publisher ↗
INTRODUCTION: Neuromyelitis optica spectrum disorder (NMOSD) and MOG-associated disease (MOGAD) present high risk of disability. Early testing for anti-aquaporin-4 (AQP4) and anti-myelin oligodendrocyte glycoprotein (MOG...INTRODUCTION: Neuromyelitis optica spectrum disorder (NMOSD) and MOG-associated disease (MOGAD) present high risk of disability. Early testing for anti-aquaporin-4 (AQP4) and anti-myelin oligodendrocyte glycoprotein (MOG) antibodies is crucial for timely diagnosis and better outcomes. However, patient awareness of these antibodies and their understanding about their disease remains poorly characterized. OBJECTIVES/AIMS: To assess the frequency of antibody serostatus awareness and diagnosis recognition among patients with NMOSD and MOGAD in a tertiary outpatient clinic. METHODS: In this cross-sectional study (March 2023 to October 2024), we surveyed patients with AQP4-positive NMOSD, MOGAD and double-seronegative optic neuritis or longitudinally extensive transverse myelitis with a structured questionnaire evaluating their understanding of diagnosis and antibody status. We extracted demographic and clinical data from medical records and analyzed factors related to disease awareness. RESULTS: We included 98 patients (81 % female): 57 with AQP4-positive NMOSD, 16 with MOGAD, and 25 double-seronegative. Median age at diagnosis was 36 years (IQR 30-47.5). Self-reported ethnicity was Black or mixed in 63 %, White in 32 %, and Asian in 5 %. Median years of education was 12 (IQR 8-12). Awareness of antibody status was reported by 34/57 (60 %) AQP4-positive and 11/16 (69 %) MOGAD patients. In univariate analyses, antibody awareness was associated with years of education (p = 0.0006), age at diagnosis (p = 0.0001), and age at onset (p = 0.001). In multivariable analysis, years of education remained independently associated, with each additional year increasing the odds of awareness by 32 % (OR 1.32, 95 % CI 1.11-1.63). CONCLUSION: Almost half of the patients lacked information about their antibody status. Better communication and patient education could strengthen understanding, promote engagement in care, and reduce delays in diagnosis and treatment. Questions about how social determinants of health may impact in aptitude to hunt for proper and early diagnosis and treatment need to be more evaluated in the NMOSD/MOGAD scenario.
Butzkueven H, Farr P, Ozakbas S
… +23 more, Boz C, Kalincik T, Taylor L, Van Der Walt A, Alroughani R, Buzzard K, Skibina O, Lechner-Scott J, Laureys G, Terzi M, Van Pesch V, Grand-Maison F, Barnett M, Kermode A, Menoyo JLS, Rojas J, Willekens B, Foschi M, Ramo-Tello C, Skromne E, Dirks P, Rouzic EM, Spelman T
Mult Scler Relat Disord
· 2026 May · PMID 41963004
·
Publisher ↗
Mult Scler Relat Disord
· 2026 Jun · PMID 41962305
·
Publisher ↗
BACKGROUND: The Expanded Disability Status Scale (EDSS) is a gold-standard disability measure in multiple sclerosis (MS) notwithstanding its inbuilt bias towards pyramidal function. OBJECTIVES: To determine whether diffe...BACKGROUND: The Expanded Disability Status Scale (EDSS) is a gold-standard disability measure in multiple sclerosis (MS) notwithstanding its inbuilt bias towards pyramidal function. OBJECTIVES: To determine whether differences in EDSS-measured disability severity reflect the neuropsychiatric sequelae of MS. METHODS: In a consecutive sample of 1277 people with a confirmed diagnosis of relapsing-remitting MS (RRMS), EDSS scores were classified as "no disability" (0-1.0), "mild disability" (1.5-2.5), and "moderate-severe disability" (3.0-7.5). The ability of the EDSS (compared to a reference level of "mild disability") to predict global cognitive impairment (GCI; assessed with the Minimal Assessment of Cognitive Function in MS), anxiety and depression (Hospital Anxiety and Depression Scale anxiety and depression sub-scales), fatigue (Modified Fatigue Impact Scale), and self-perception of deficits (Perceived Deficit Questionnaire) was determined with regression analyses (linear or logistic where appropriate). RESULTS: Mean age was 41.79 years (SD=10.27), 75.47% were female, and median EDSS was 2.0 (IQR=1.5-2.5). "No disability" was associated with less GCI (OR=0.71), depression (β=-0.09) and fatigue (β=-0.09) and fewer perceived deficits (β=-0.09), all p < 0.05. "Moderate-severe disability" was associated with increased GCI (OR=2.39), depression (β=0.10), and fatigue (β=0.13), all p < 0.05. CONCLUSIONS: Increased EDSS-measured disability is accompanied by rises in GCI, depressive symptoms, and fatigue, but not anxiety.
Silva BA, Federico MB, Lázaro L
… +12 more, Casas M, Burgos M, Maniella C, Tavolini D, López P, Carnero Contentti E, Tkachuk V, Vrech C, Zárate MA, Rojas JI, Alonso R, Elgart J
Mult Scler Relat Disord
· 2026 Jun · PMID 41962304
·
Publisher ↗
BACKGROUND: Published real-world evidence on the direct and indirect costs associated with infused disease-modifying treatments (IV-DMTs) for relapsing-remitting multiple sclerosis (RRMS) remains scarce in Argentina and...BACKGROUND: Published real-world evidence on the direct and indirect costs associated with infused disease-modifying treatments (IV-DMTs) for relapsing-remitting multiple sclerosis (RRMS) remains scarce in Argentina and Latin America. OBJECTIVE: To estimate first-year real-world direct and indirect costs of IV-DMTs [ocrelizumab (OCR), alemtuzumab (ATZ) and natalizumab (NTZ)] in RRMS patients in Argentina. METHODS: We conducted a non-interventional study of adult RRMS patients who initiated IV-DMTs between August 2018 and August 2020. Resource use and costs were collected via an ad hoc questionnaire. Direct and indirect costs were calculated using unit costs in Argentine pesos (December 2022) and converted to US dollars (1 USD = AR$172.9). RESULTS: A total of 125 patients were analysed (mean age 35.9 years; disease duration 8.9 years; EDSS 2.0). The most frequently used IV-DMTs were NTZ (51.2%), OCR (33.6%), and ATZ (15.2%). Total annual costs averaged USD 62,831 ± 14,813 per patient, with the DMT itself accounting for 85% of total costs. By treatment, first-year costs were USD 85,293 for ATZ; USD 56,140 for NTZ; and USD 62,867 for OCR. Costs did not differ by sex or EDSS. CONCLUSION: First-year IV-DMT costs averaged USD 62,831, approximately 4.5 times the Argentine GDP per capita, highlighting the substantial economic burden of these treatments in Argentina.
Mult Scler Relat Disord
· 2026 Jun · PMID 41955667
·
Publisher ↗
Intermittent hypoxia intervention may provide an alternative therapeutic approach to enhance neuroprotection in people with multiple sclerosis (pwMS). However, clinical data on its safety and feasibility in pwMS are lack...Intermittent hypoxia intervention may provide an alternative therapeutic approach to enhance neuroprotection in people with multiple sclerosis (pwMS). However, clinical data on its safety and feasibility in pwMS are lacking. In this prospective single-arm safety and feasibility trial, individuals with primarily progressive MS (18-60 years; Expanded Disability Status Scale ≤6.5) were recruited from the MS outpatient clinic of the University Medical Center Hamburg-Eppendorf and underwent a 12-week repetitive continuous hypoxia (RCH). Participants completed two to three standardized 2-hour sessions per week simulating altitudes of up to 4,500 meters, corresponding to a minimum fraction of inspired oxygen of 11%. The primary outcome was the occurrence of acute high-altitude sickness, assessed using the Lake Louise Score (LLS). Secondary outcomes included systemic adverse events, adherence, disability measures, patient-reported outcomes, neuropsychological screening tests, MRI disease activity, immune cell subpopulations in peripheral blood, serum neurofilament light chain levels, and serum metabolomic profiles. Twelve pwMS were enrolled, and ten completed the intervention. No participant developed moderate or severe symptoms of high-altitude illness, and no systemic safety concerns or worsening of clinical, radiological, or laboratory parameters were observed over the intervention period. Exploratory analyses suggested improvements in disability-related outcomes. These findings indicate that a 12-week RCH is safe and feasible in pwMS and support further investigation in larger, controlled trials.
Buijze MSJ, Molenaar S, Smets I
… +4 more, Bruijstens AL, van Garderen K, Loudon SE, Neuteboom RF
Mult Scler Relat Disord
· 2026 Jun · PMID 41950618
·
Publisher ↗
BACKGROUND: The 2024 revisions of the multiple sclerosis (MS) diagnostic criteria emphasize the importance of identifying optic nerve demyelinating lesions. The objective of this study was to validate optical coherence t...BACKGROUND: The 2024 revisions of the multiple sclerosis (MS) diagnostic criteria emphasize the importance of identifying optic nerve demyelinating lesions. The objective of this study was to validate optical coherence tomography (OCT) intereye difference (IED) metrics for identifying prior optic neuritis (ON) in children and subclinical optic nerve lesions in pediatric MS. METHODS: OCT scans from children with MS, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and seronegative acquired demyelinating syndromes (ADS) were analyzed in a cross-sectional study of a nationwide Dutch cohort. Absolute and percentage IED (IEAD, IEPD) in peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell-inner plexiform layer (mGCIPL) thickness were used as indicators of optic nerve demyelination. Diagnostic accuracy was calculated with ROC curve analysis. RESULTS: The analysis included high-quality optic disc scans of both eyes from 50 children (n=23 MS, n=19 MOGAD, n=8 seronegative ADS) and high-quality macular scans of both eyes from 47 children (n=23 MS, n=15 MOGAD, n=9 seronegative ADS). Overall, pRNFL IED outperformed mGCIPL IED (area under the curve pRNFL: 0.88 [IEAD], 0.90 [IEPD]; mGCIPL: 0.78 [IEAD], 0.74 [IEPD]). Children with bilateral ON demonstrated lower diagnostic value. In pediatric MS, pRNFL IED metrics demonstrated high sensitivity (83.3% for IEAD; 100% for IEPD) and specificity (94.1% for IEAD and IEPD). In children with MS without ON, OCT suggested subclinical optic nerve lesions in up to 22%, often with complementary signs of demyelination. CONCLUSIONS: OCT IED metrics detect prior clinical unilateral ON and may also identify subclinical optic nerve lesions.
Mult Scler Relat Disord
· 2026 Jun · PMID 41946090
·
Publisher ↗
There is a disconnect between the language preferences of people with multiple sclerosis (MS) and the language used to refer to them in research outputs. Authors continue to use terms such as "patient" or "sufferer," acr...There is a disconnect between the language preferences of people with multiple sclerosis (MS) and the language used to refer to them in research outputs. Authors continue to use terms such as "patient" or "sufferer," acronyms such as "PwMS" or "PLwMS," and identity-first language (in contrast to person-first language) when referring to people with MS and their symptoms and comorbidities. Such language may be disrespectful or contextually inaccurate and may influence healthcare interactions in ways that do not align with the principles of person-centred care. Although further research is needed to better understand the complex relationships between demographic and health-related factors and disability language preferences among people with MS, the language used in research outputs should be guided by respect. In this commentary, we encourage authors to carefully consider how people with MS are referred to in relation to their health condition, disability, symptoms, and comorbidities.
Ricigliano VA, Szejko N, Camera V
… +3 more, Gomez-Figueroa E, Selmaj KW, Samadzadeh S
Mult Scler Relat Disord
· 2026 Jun · PMID 41946089
·
Publisher ↗
Multiple sclerosis (MS) is a chronic autoimmune disorder characterized by inflammation, demyelination, and neuronal loss, with significant public health impact. Despite important therapeutic advances, major unmet needs r...Multiple sclerosis (MS) is a chronic autoimmune disorder characterized by inflammation, demyelination, and neuronal loss, with significant public health impact. Despite important therapeutic advances, major unmet needs remain, mainly in targeting neurodegeneration, blocking progression independent of relapse activity and fostering remyelination. Several compounds tested to address some of these processes yielded negative or inconclusive results, forcing researchers, clinicians and industry to look for alternative molecules to alter key underlying pathways. The aim of this study was to examine trials that failed due to negative or inconclusive results between October 2019 and October 2024. A literature review was conducted using MEDLINE, clinical trial databases, and international conference proceedings to identify both published and unpublished failed phases I-III and randomized controlled trials, which were analyzed based on their primary study endpoints. Studies that focused solely on secondary outcomes of MS, such as spasticity or cognitive impairment, were excluded. 17 distinct investigational agents were identified, spanning across seven therapeutic classes: immune-active agents, neuroprotective/metabolic modulators, remyelination antibodies, hormones, antivirals, vitamins/nutraceuticals, and regenerative growth factors. Although some compounds demonstrated biological activity-such as reduced MRI lesion counts with Bruton's tyrosine kinase inhibitors or improved visual evoked potentials with remyelination antibodies-none met their pre-specified primary endpoints in adequately powered settings. Safety concerns, heterogeneous patient populations and insensitive traditional endpoints further limited trial success. In conclusion, while many novel therapies have demonstrated mechanistic promise in MS, key challenges remain in producing durable outcomes on disability accumulation, ensuring drug tolerability, promoting sustained repair and achieving commercial viability.
Mirmosayyeb O, Mohammadi M, Mohammadi A
… +5 more, Yazdan Panah M, Vaheb S, Shaygannejad A, Balconi J, Shaygannejad V
Mult Scler Relat Disord
· 2026 Jun · PMID 41936244
·
Publisher ↗
BACKGROUND: The Type D personality has been linked to worse outcomes in chronic diseases, but its role in multiple sclerosis (MS) disability is not well established. The study aimed to compare demographic and clinical ch...BACKGROUND: The Type D personality has been linked to worse outcomes in chronic diseases, but its role in multiple sclerosis (MS) disability is not well established. The study aimed to compare demographic and clinical characteristics of MS patients with and without a Type D personality and to explore their associations with Type D personality. METHODS: In this cross-sectional study, 350 people with MS (PwMS) were recruited from a tertiary MS clinic in Iran from August 2024 to May 2025. Demographic and clinical data, including MS subtype and disability measured by the Expanded Disability Status Scale (EDSS), were collected through clinical evaluation and medical records. Personality traits were assessed using the Persian version of the NEO Five-Factor Inventory, and Type D personality was defined as high Neuroticism (T-score ≥ 60) and low Extraversion (T-score ≤ 40). Group comparisons and univariate and multivariate regression analyses were performed to examine associations between Type D personality and clinical and demographic characteristics. RESULTS: Among participants (70.9 % female, median age 38 years), 14.9 % had Type D personality. The prevalence of Type D personality was 11.1 % in relapsing-remitting MS and 32.2 % in progressive MS. Compared to PwMS without Type D personality, PwMS with Type D personality had higher median EDSS (2.5 vs. 1.0, p < 0.001), and greater EDSS worsening (delta EDSS: 1.0 vs. -0.5, p < 0.001). Regression analysis showed that having a Type D personality (B = 0.87, 95 % CI: 0.61-1.14, p < 0.001) and the EDSS score recorded at the initial clinical evaluation near disease onset (B = 0.91, 95 % CI: 0.76-1.06, p < 0.001) were associated with current EDSS. CONCLUSION: Type D personality was more prevalent in people with progressive MS and was associated with higher disability levels. These findings support incorporating personality assessments into MS care and exploring targeted psychosocial strategies for at-risk patients.
Sadou Y, Rousseau MC, Leffondre K
… +2 more, Larochelle C, Mésidor M
Mult Scler Relat Disord
· 2026 Jun · PMID 41936243
·
Publisher ↗
BACKGROUND: Polypharmacy in individuals with multiple sclerosis (MS) is associated with reduced quality of life. There is limited evidence on the long-term use of any medication and its evolution among individuals living...BACKGROUND: Polypharmacy in individuals with multiple sclerosis (MS) is associated with reduced quality of life. There is limited evidence on the long-term use of any medication and its evolution among individuals living with MS in the province of Quebec, Canada. OBJECTIVE: To identify medication trajectories and describe characteristics of individuals within these trajectories. METHODS: In a birth cohort, people with MS were identified from a validated algorithm based on use of health services from 1997 onward. Those covered by public drug insurance during at least three years until 2014 were included. Latent class growth analysis was used. RESULTS: A total of 551 people with MS were included (74% women, median age at diagnosis 31 years). Four medication trajectories were identified and remained mostly stable over a decade: low (n=143), moderate (n=248), high (n=129) and very high (n=31). Among 443 persons covered by public drug insurance in the post-diagnosis year, the median number of medications by trajectory was: 1 (low, n=107), 4 (moderate, n=201), 7 (high, n=107), and 14.5 medications (very high, n=28), respectively. Female sex, older age at diagnosis, rural place of residence, and greater material deprivation were more common in the very high medication group. People in the high medication trajectories tended to have more MS-healthcare visits with general practitioners but less with neurologists. Central nervous system drugs were the most claimed medications. CONCLUSION: Distinct medication trajectories were identified with variation in age at MS diagnosis, sex, residence area and material deprivation across groups.
Busaeed RB, Makkawi S, Almasaad JM
… +7 more, Banjar O, Altayeb A, Alhuzali A, Attar M, Althagafi M, Alotibi MN, Bakadam T
Mult Scler Relat Disord
· 2026 Jun · PMID 41935523
·
Publisher ↗
BACKGROUND: Epilepsy is a well-established comorbidity in multiple sclerosis (MS), with higher prevalence among MS patients than in the general population. This study determines the prevalence of epilepsy in MS patients...BACKGROUND: Epilepsy is a well-established comorbidity in multiple sclerosis (MS), with higher prevalence among MS patients than in the general population. This study determines the prevalence of epilepsy in MS patients and identifies associated risk factors in a Saudi cohort. METHODS: This cross-sectional study included adult MS patients at King Abdulaziz Medical City, Jeddah, Saudi Arabia, between 2016 and 2024. Data were retrospectively collected from electronic medical records. Statistical analyses assessed associations between epilepsy and MS-related variables. RESULTS: Among 602 MS patients, 22 had epilepsy, yielding a prevalence of 3.65% (95% CI: 2.16%-5.15%). MS patients with epilepsy were significantly older (median: 45 years) than those without (median: 39 years; p = 0.043). Focal onset motor seizures (50%) and generalized tonic-clonic seizures (42.9%) were most common. MRI revealed cortical lesions in 59%, juxtacortical in 22.7%, and subcortical in 13.6%. Age was a significant predictor, with each additional year increasing epilepsy risk by 5% (OR: 1.05; 95% CI: 1.01-1.09; p = 0.026). CONCLUSION: This study confirms increased epilepsy prevalence among MS patients in Saudi Arabia. Older age is a key risk factor, emphasizing the importance of early screening and management strategies.
Serrazina F, Mendes AS, Fonseca IR
… +3 more, Krupka D, Costa JB, Salavisa M
Mult Scler Relat Disord
· 2026 Jun · PMID 41935522
·
Publisher ↗
INTRODUCTION: Intrathecal immunoglobulin-G synthesis is a pathological hallmark of multiple sclerosis (MS). Cerebrospinal fluid (CSF) kappa-free light chain (κFLC) detection has emerged as a new biomarker in MS, but litt...INTRODUCTION: Intrathecal immunoglobulin-G synthesis is a pathological hallmark of multiple sclerosis (MS). Cerebrospinal fluid (CSF) kappa-free light chain (κFLC) detection has emerged as a new biomarker in MS, but little is known about its expression and variance across distinct patient subgroups. OBJECTIVE: To assess and compare intrathecal synthesis through kFLC index between patients with early and late onset MS. METHODS: An exploratory retrospective single-center cohort study including consecutively diagnosed MS patients was conducted. Nephelometric kFLC measurements of paired serum/CSF samples collected at MS diagnosis were obtained. A cut-off for increased κFLC index was established at ≥6.1 as per previous published reports. Two groups were defined: early onset (EO) patients (first MS symptoms < 50 years) and late onset (LO) patients (first MS symptoms ≥ 50 years). RESULTS: Sixty (60) patients were included, 42(70 %) female, with a mean age of 48.3 years (±14.3; min18-max79) and a mean disease duration of 5.2 years (± 4.8; min 0.5-máx 23). 25 (41.7 %) LO patients were included. Groups did not differ in demographic or clinical variables. Although the prevalence of CSF-restricted OCB was similar between groups (EO n = 31, 88.6 %; LO n = 22, 88,0 %, p = 1.000), the prevalence of a kFLC index >6.1 was significantly higher in LO MS patients (n = 22, 88.0 % vs EO n = 22, 62,9 % p = 0.040). CONCLUSION: In this cohort, a higher prevalence of increased kFLC index was found among patients with late-onset MS. This may reflect a longer period of intrathecal dysimune reactions connected to MS pathological onset, even if not clinically expressed until later stages.
Schimpf BV, Marrodan M, Hernandez M
… +4 more, Köhler AA, Fiol M, Ysrraelit MC, Correale J
Mult Scler Relat Disord
· 2026 Jun · PMID 41932013
·
Publisher ↗
INTRODUCTION: The presence of multiple spinal cord lesions has been suggested as an additional risk factor for conversion. However, their prognostic significance in the absence of brain lesions remains uncertain. OBJECTI...INTRODUCTION: The presence of multiple spinal cord lesions has been suggested as an additional risk factor for conversion. However, their prognostic significance in the absence of brain lesions remains uncertain. OBJECTIVE: To determine whether baseline spinal cord MRI features predict conversion to multiple sclerosis in patients presenting with isolated myelitis, and to compare baseline clinical, radiological, and paraclinical characteristics between converters and non-converters. METHODS: A retrospective cohort study involving patients with a first episode of acute or subacute myelitis, without brain lesions at baseline MRI was conducted. All patients underwent a standardized diagnostic evaluation including brain and spinal MRI with contrast, cerebrospinal fluid analysis, and serum testing for aquaporin-4 and MOG antibodies to confirm inflammatory myelitis and exclude alternative etiologies. Clinical and paraclinical variables were analyzed. RESULTS: We evaluated 112 patients, of whom 33% converted to MS during a median follow-up of 32.6 months. Multiple asymptomatic spinal cord lesions were associated with a higher risk of conversion to MS (HR=2.04; 95%CI:1-3.9; p = 0.03), even after adjusting for age, female sex, and the presence of gadolinium-enhancing lesions. Patients who converted to MS more frequently had cervical lesions (70% vs. 44%; p = 0.01) and were significantly younger at onset (median 34.8 vs. 42 years; p = 0.02). CONCLUSION: Multiple asymptomatic spinal cord lesions are associated with a higher risk of conversion to MS, supporting their value as a radiological marker of risk.