Evidence map›Paper›PMID 41051611›Full record

Observational studyJournal of neurology2025

Critical demyelinating lesions in progressive multiple sclerosis: a prospective observational study.

Rowaid Ahmad, Caitlin S Jackson-Tarlton, Eoin P Flanagan, Steven Messina, W Scott Harmsen, Tuba Chaudhry, Nabeela Nathoo, W Oliver Tobin, Michel Toledano, Sean J Pittock and 4 more

Abstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Journal of neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Review
  2. Article
  3. Article
  4. Review
  5. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Rowaid Ahmad *Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
Caitlin S Jackson-Tarlton *Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
Eoin P FlanaganDepartment of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
Steven MessinaDepartment of Radiology, Mayo Clinic, Rochester, MN, USA.
W Scott HarmsenDepartment of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
Tuba ChaudhryDepartment of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
Nabeela NathooDepartment of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
W Oliver TobinDepartment of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
Michel ToledanoDepartment of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
Sean J PittockDepartment of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
Claudia F LucchinettiDepartment of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
Brian G WeinshenkerDepartment of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
Orhun H KantarciDepartment of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
B Mark KeeganDepartment of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. keegan.bmark@mayo.edu.ORCID http://orcid.org/0000-0002-2880-935X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectiveCritical demyelinating lesions are individual lesions anatomically associated with progressive motor impairment initially described in highly selected cohorts with demyelinating disease. We aim to determine how frequently individual critical demyelinating lesions were found in an unselected consecutive cohort of people with progressive multiple sclerosis (MS) at a tertiary MS clinic over a one-year duration.

methodsProspective consecutively enrolled observational cohort study of newly evaluated and established people with progressive MS at Mayo Clinic from July 1, 2021 to June 30, 2022. Demographics and clinical information were extracted by chart review following evaluation by an MS subspecialty expert. Participants were evaluated as having predominantly progressive motor or non-motor (ataxic, cognitive, sensory) impairment. All brain and spinal cord MRIs were examined for demyelinating lesions involving the corticospinal motor tracts. Critical lesions were defined as T2 lesions anatomically associated with a progressive upper motor neuron impairment within the lateral columns, brainstem corticospinal tracts, or supra-tentorial corticospinal tracts. Participants were classified as having: A) one critical lesion; B) two "tandem" critical lesions or C) lesion burden too high (i.e., ≥ 3 critical tandem lesions where individual lesions could not reliably associated with motor progression).

results255 participants were evaluated: 67 (26.3%) with critical lesions, (54 [21.2%] with one critical, and 13 [5.1%] with two tandem critical lesions) and 188 (73.7%) with lesion burden too high. Non-motor progression was found in 15 (5.9%). Critical lesions were identified in most within the spinal cord (cervical in 49 [90.7%] and thoracic in 3 [5.5%]). Those with critical lesions were older at evaluation than those with lesion burden too high (median 62 years IQR 55-68 vs. 58.0 IQR 49-64, p = 0.004), more likely to present with progressive hemiparesis (55.2% vs 14.4%, p < 0.001), and less likely to present with progressive para-paresis (4.5% vs 31.9% p < 0.001) or quadriparesis (1.5% vs 10.1%, p = 0.031). These groups had similar numbers of brain demyelinating lesions. DISCUSSION: Critical demyelinating lesions, often within the spinal cord and anatomically associated with progressive motor impairment, are commonly found in people with progressive MS.

Indexed as

Demyelinating DiseasesMultiple Sclerosis, Chronic ProgressivePyramidal TractsSpinal CordAdultAgedDisease ProgressionFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedProspective StudiesDemyelinating diseaseExpanded disability status scale scoreMultiple sclerosisProgressive multiple sclerosis

Identifiers

PMID41051611

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.