Environmental risk factors and conversion to multiple sclerosis in subjects with radiologically isolated syndrome: a case–control study

Background and objectivesRadiologically isolated syndrome (RIS) is the incidental finding of lesions typical for multiple sclerosis (MS) on magnetic resonance imaging in asymptomatic individuals. We investigated which environmental factors are associated with a first clinical event in RIS patients.MethodsSubjects presenting as RIS (cases) or as clinically isolated syndrome (CIS)/relapsing-remitting multiple sclerosis (RRMS) at onset (controls) were included. Patients were administered an environmental questionnaire. The distribution of clinical and demographic characteristics and environmental factors was analysed. RIS subjects were divided according to time of conversion to MS and clinical and demographic characteristics and environmental factors were investigated as risk factors for conversion.ResultsFifty-two RIS and 216 controls were included. Controls were younger at diagnosis (33.4 vs 39.0 years old), while RIS patients had more frequent onset with supratentorial symptoms (26.9% vs 8.3%). Spending more time outdoor during childhood was associated with a higher risk of a CIS/RRMS onset (odds ratio (OR) 0.24, 95% confidential interval (CI): 0.09-0.65, p = 0.0049). RIS that converted within 5 years were more likely to be underweight during adolescence (hazard ratio (HR) 11.57, 95% CI: 2.45-54.61, p = 0.0020), to have had pregnancy losses (HR 4.48, 95% CI: 1.35-14.88, p = 0.0145) and to have used assisted reproduction technology (ART) before RIS diagnosis (HR 20.42, 95% CI: 2.82-147.82, p = 0.0028).DiscussionBeing underweight during adolescence, the use of ART and a history of pregnancy losses led to a higher risk of conversion from RIS to MS. Outdoor activity during childhood was more frequent in patients with CIS/RRMS.