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Radiologically isolated syndrome.

Christine Lebrun-Frenay1, Orhun Kantarci2, Aksel Siva3

  • 1CRC-SEP Nice, Neurologie CHU Nice, Hôpital Pasteur 2, UMR2CA-URRIS, Université Côte d'Azur, Nice, France.

The Lancet. Neurology
|October 15, 2023
PubMed
Summary
This summary is machine-generated.

Radiologically isolated syndrome (RIS) may indicate a presymptomatic stage of multiple sclerosis. Early treatment with immunomodulatory medications shows promise in preventing clinical conversion in high-risk individuals.

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Area of Science:

  • Neurology
  • Radiology
  • Immunology

Background:

  • Radiologically isolated syndrome (RIS) is characterized by incidental demyelinating lesions suggestive of multiple sclerosis (MS) without clinical symptoms.
  • Longitudinal data suggest approximately 50% of individuals with RIS progress to symptomatic MS within 10 years, indicating RIS may be a presymptomatic phase of MS.

Purpose of the Study:

  • To review the current understanding of radiologically isolated syndrome (RIS) and its progression to multiple sclerosis (MS).
  • To identify risk factors and potential biomarkers for MS development in individuals with RIS.
  • To evaluate the efficacy of early immunomodulatory treatment in preventing clinical conversion in RIS.

Main Methods:

  • Review of international longitudinal cohort data on RIS progression.
  • Analysis of risk factors including age, sex, cerebrospinal fluid (CSF) oligoclonal bands, lesion location, and gadolinium enhancement.
  • Evaluation of data from two randomized clinical trials on immunomodulatory treatments for RIS.

Main Results:

  • Key risk factors for progression to clinical MS include younger age (<35), male sex, CSF-restricted oligoclonal bands, spinal cord/infratentorial lesions, and gadolinium-enhancing lesions.
  • Two clinical trials demonstrated that approved MS immunomodulatory medications can prevent clinical conversion in some individuals with RIS over a 2-year period.

Conclusions:

  • RIS represents a potential presymptomatic stage of MS, with identifiable risk factors for progression.
  • Early intervention with immunomodulatory therapies may alter the disease course for high-risk individuals with RIS, potentially transforming patient care.