Optic coherence tomography follow-up and cerebrospinal fluid inflammatory markers in newly diagnosed multiple sclerosis and clinical isolated syndrome patients and their effect on progrnosis

Introduction and Aim: Multiple Sclerosis (MS) is an autoimmune, inflammatory, and neurodegenerative disease of the CNS. It is characterized by T and B lymphocytes, activated monocytes, and microglia mediated blood brain barrier damage and inflammation, resulting in myelin and axon damage in various areas of the CNS. In recent years, many biomarkers have been studied to predict MS diagnosis, disease susceptibility, treatment response and prognosis. The clinical significance of many of these markers has not been determined, and a significant and specific relationship with the course of the disease could not be obtained in clinical practice. In this study, we aimed to evaluate the relationship between attack type, attack frequency, EDSS scores, magnetic resonance imaging, CSF findings and optical coherence tomography (OCT) parameters and serum neurofilament light chain (NfL) and IL-13 levels in newly diagnosed MS patients. Methods: A total of 33 newly diagnosed patients who had not received any treatment before were included in our retrospective study. Peripapillary retinal nerve fiber layer (pRNFL) and macular nerve fiber layer (NFL), ganglion cell layer and inner plexiform layer aggregates (GCIPL), inner nuclear layer volumes (INL), and central macular thickness (CMT) were recorded on OCT images performed on the same day as the lumbar puncture. The patients were divided into two groups according to their diagnosis as clinically isolated syndrome (CIS) and relapsing remitting MS (RRMS). Age, gender, disease duration, number of attacks, attack type (brainstem, sensory, pyramidal, optic neuritis, spinal, cerebellar), other concomitant diseases, EDSS (expanded disability status scale) scores, previously checked vitamin D levels of all patients were recorded. Cranial and spinal imaging findings of all patients previously taken and recorded in the system were evaluated. In this evaluation, T2 lesion load, lesion distribution (supratentorial, infratentorial, spinal), and contrast enhancement pattern were recorded. The presence and type of oligoclonal band, IG G index were recorded in the atraumatic cerebrospinal fluid examination at the time of diagnosis, and 2 cc CSF in polypropylene tubes was separated after obtaining consent from the patients. For CSF NfL and IL-13 levels, the samples were stored under suitable conditions at -80oC after centrifugation and aliquoting and studied with the ELISA method. Results: 33 patients (25 female, 8 male) were included in the study. Seven of the patients (10.6%) were diagnosed with clinical isolated syndrome, 25 (37.9%) RRMS, and 1 patient (1.5%) with PPMS. The mean age of the patients was 30.8 ± 8.9 years. 22 patients who had additional OCT studies at 6 months were included on the OCT longitudinal analysis in which we found tvINL and tvGCIPL values decreased significantly (p <0.05) compared to the first measurement. A significant (p <0.05) negative correlation was observed between EDSS value and CMT value. A significant (p <0.05) negative correlation was observed between NfL level and tRNFL. A significant (p <0.05) positive correlation was observed between vitamin D value and CMT and tvNFL. There was no significant difference in NfL and IL-13 levels between the attack and non-attack groups in the follow-up (p>0.05). Conclusion: Our study supports that OCT follow-ups and CSF NfL values are useful in determining the prognosis in multiple sclerosis. More studies are needed to determine the importance of IL-13 in MS. More comprehensive studies may guide the treatment decision and predict the prognosis.