Evidence map›Paper›PMID 42440141›Full record

ArticleJournal of neurology2026

Clinical course of critical demyelinating lesion-associated progressive multiple sclerosis.

Tuba S Chaudhry, Nabeela Nathoo, Bianca Albites Coen, Purnashree Chowdhury, Rowaid Ahmad, Caitlin S Jackson-Tarlton, Eoin P Flanagan, Claudia Lucchinetti, Sean J Pittock, W Oliver Tobin and 5 more

Abstract read
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Article in Journal of neurology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing 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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

15 authors.

Tuba S Chaudhry *Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Nabeela Nathoo *Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Bianca Albites CoenDepartment of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Purnashree ChowdhuryDepartment of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Rowaid AhmadDepartment of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Caitlin S Jackson-TarltonDepartment of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Eoin P FlanaganDepartment of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Claudia LucchinettiDepartment of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Sean J PittockDepartment of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
W Oliver TobinDepartment of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Michel ToledanoDepartment of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Brian WeinshenkerDepartment of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Steven A MessinaDepartment of Radiology, Mayo Clinic, Rochester, MN, USA.
Orhun H KantarciDepartment of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
B Mark KeeganDepartment of Neurology, Mayo Clinic, 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

backgroundProgressive multiple sclerosis (MS) is usually associated with progressive asymmetrical motor impairment. A single critical demyelinating lesion anatomically associated with motor impairment was seen in > 20% of patients with progressive MS. The assessment of critical lesion-associated progressive MS requires understanding their clinical course, how prior inflammatory relapse location and their first MRI appearance relates to progressive motor impairment.

objectivesTo determine: (1) clinical course and prior relapse location and (2) interval between first MRI critical lesion evidence and progressive motor impairment in patients with progressive MS with a single critical lesion.

methodsProspective, consecutively accrued patients with progressive MS were seen at a tertiary MS clinic (July 1, 2021-June 30, 2022). Patients with one critical lesion anatomically associated with progressive motor impairment were included. Patients with two or more tandem critical lesions along the same corticospinal tract or too extensive demyelinating lesion burden to determine the association between motor impairment and one critical lesion were excluded. A location-related relapse (LRR) was defined as a prior acute inflammatory demyelinating event at the same CNS site subsequently identified with critical lesion-associated motor progression. Clinical course was progressive from onset [primary progressive MS (PPMS)] or relapse-onset [secondary progressive MS (SPMS)] with SPMS dichotomized to those with or without LRR. MRIs were reviewed determining the earliest MRI critical lesion appearance and duration between this and the onset of progressive motor impairment.

results53 of 266 (20%) patients with progressive MS had a single critical lesion associated with motor progression. Clinical course was SPMS in 36/53 (68%) and PPMS in 17/53 (32%). SPMS critical lesion onset was LRR-associated in 26/36 (72%). Critical lesion was first MRI-evident a median of 2.2 years before the onset of motor progression in SPMS (IQR -1.7 to 4.6) and -4.5 years (IQR -10.6 to -2.5) in PPMS with negative values indicating first MRI evidence came after motor progression onset.

conclusionIn people with a single critical lesion-associated motor progression, this typically presents as SPMS and often follows an LRR. This emphasizes the anatomic association between initial lesion-associated inflammatory presentation and subsequent motor progression.

Indexed as

Demyelinating DiseasesDisease ProgressionMultiple Sclerosis, Chronic ProgressiveAdultFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedProspective StudiesCorticospinal tractCritical demyelinating lesionMultiple sclerosisPrimary progressive multiple sclerosisSecondary progressive multiple sclerosis

Identifiers

PMID42440141

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.