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Tibial nerve SSEP (tSSEP) were less frequently abnormal than SC MRI (22% vs. 68%,<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). However, higher EDSS scores were significantly associated with abnormal tSSEP (median, 2.0 vs. 1.0;<jats:italic>p<\/jats:italic>\u2009=\u20090.001) but not with abnormal SC MRI (i.e., at least one lesion; median, 1.5 vs. 1.5;<jats:italic>p<\/jats:italic>\u2009=\u20090.7). Of the 35 patients with abnormal tSSEP, 32 had lesions on SC MRI, and 2 had corresponding lesions on brain MRI.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Compared to tSSEP, SC MRI is the more sensitive diagnostic biomarker regarding SC involvement. In early MS, lesions as detectable by T2-weighted MRI are the main driver of abnormal tSSEP. 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Alexander Wuschek, Matthias Bussas, Malek El Husseini, Laura Harabacz, Viktor Pineker, Isabelle Riederer, and Claus Zimmer have nothing to disclose. Viola Pongratz received research funding from Novartis (Oppenheim F\u00f6rderpreis 2017). Jan S. Kirschke has received research funding from the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG; project 432290010), the German Federal Ministry of Education and Research (13GW0469D) and the European Research Council (ERC) under the European Union\u2019s Horizon 2020 research and innovation programme (101045128\u2014iBack-epic\u2014ERC-2021-COG). He is Co-Founder of Bonescreen GmbH. Achim Berthele has received consulting and\/or speaker fees from Alexion, Bayer Healthcare, Biogen, Celgene, Novartis, Roche and Sandoz\/Hexal. His institution has received compensation for clinical trials from Alexion, Biogen, Merck, Novartis, Roche, and Sanofi Genzyme. Bernhard Hemmer is associated with DIFUTURE (Data Integration for Future Medicine) [BMBF 01ZZ1804[A-I]]. Bernhard Hemmer received funding from the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany\u2019s Excellence Strategy within the framework of the Munich Cluster for Systems Neurology [EXC 2145 SyNergy\u2014ID 390857198] and the European Union\u2019s Horizon 2020 Research and Innovation Program [grant MultipleMS, EU RIA 733161]. He has served on scientific advisory boards for Novartis; he has served as DMSC member for AllergyCare, Sandoz, Polpharma and TG therapeutics; he or his institution have received speaker honoraria from Desitin; his institution received research grants from Regeneron for multiple sclerosis research. He holds part of two patents; one for the detection of antibodies against KIR4.1 in a subpopulation of patients with multiple sclerosis and one for genetic determinants of neutralizing antibodies to interferon. Mark M\u00fchlau received research support from the Bavarian State Ministry for Science and Art (Collaborative Bilateral Research Program Bavaria\u2014Qu\u00e9bec: AI in medicine, Grant F.4-V0134.K5.1\/86\/34), the German Research Foundation (DFG SPP2177; Radiomics: Next Generation of Biomedical Imaging; project number 428223038); the National Institutes of Health (Grant 1R01NS112161-01); the German Federal Ministry of Education and Research (DIFUTURE: 01ZZ1603[A-D] and 01ZZ1804[A-I]).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}]}}