[Radiologically isolated syndrome as a possible preclinical stage of primary-progressive multiple sclerosis]

Area of Science:

• Neurology
• Neuroimmunology
• Clinical Neuroscience

Background:

• Radiologically isolated syndrome (RIS) is an asymptomatic condition characterized by incidental findings of demyelinating lesions on MRI suggestive of multiple sclerosis (MS).
• Primary-progressive multiple sclerosis (PPMS) is a distinct clinical subtype of MS characterized by gradual neurological deterioration from onset, without distinct relapses or remissions.
• Understanding the transition from RIS to progressive forms of MS is crucial for early diagnosis and potential therapeutic interventions.

Observation:

• This article details a clinical case report documenting the transformation of radiologically isolated syndrome (RIS) to primary-progressive multiple sclerosis (PPMS).
• The case highlights the diagnostic challenges and clinical course associated with this neurodegenerative disease progression.
• Detailed clinical and MRI data were collected throughout the observation period.

Findings:

• The case report provides direct evidence of RIS evolving into PPMS, underscoring the potential neurodegenerative trajectory of this preclinical stage.
• A comprehensive review of international and Russian literature compares the clinical and MRI characteristics of PPMS with relapsing-remitting MS (RRMS) and secondary-progressive MS (SPMS).
• The review synthesizes current data on the risk factors and predictors associated with the transition from RIS to PPMS.

Implications:

• This study emphasizes the importance of long-term monitoring for individuals diagnosed with RIS to detect early signs of MS progression.
• Identifying individuals at high risk for PPMS transformation could enable earlier treatment initiation, potentially modifying disease course.
• The findings contribute to a better understanding of the heterogeneous natural history of MS and the spectrum of disease manifestation.