Early Disease-Modifying Treatments for Presymptomatic Multiple Sclerosis

Area of Science:

• Neurology
• Neuroimmunology
• Radiology

Background:

• Radiologically isolated syndrome (RIS) represents the earliest stage in the multiple sclerosis (MS) disease continuum.
• RIS is incidentally discovered in asymptomatic individuals with brain and/or spinal cord lesions suggestive of demyelination.
• Diagnostic criteria for RIS have evolved, with the 2009 and revised 2023 criteria aiming for accuracy.

Purpose of the Study:

• To summarize the revised 2023 RIS diagnostic criteria for presymptomatic individuals.
• To identify key risk factors associated with the transition from RIS to symptomatic MS.
• To highlight the role of disease-modifying treatments and the need for expert consultation in managing RIS.

Main Methods:

• Review of the 2009 and revised 2023 RIS diagnostic criteria.
• Analysis of established risk factors for symptomatic MS transition, including demographics, imaging, and laboratory biomarkers.
• Summary of findings from randomized clinical trials on disease-modifying treatments in RIS.

Main Results:

• The revised 2023 RIS criteria provide a framework for diagnosing individuals who may not meet older criteria.
• Key risk factors for transition to symptomatic MS include younger age, male sex, elevated neurofilament-light chain, CSF abnormalities, and specific lesion locations/types.
• Disease-modifying treatments have demonstrated efficacy in delaying or preventing the first clinical event in RIS.

Conclusions:

• Accurate and timely diagnosis of RIS is crucial for risk stratification and prognosis.
• Identifying individuals with higher risk factors is essential for optimizing outcomes through early intervention.
• Multidisciplinary expert MS team consultation is recommended due to the lack of comprehensive clinical guidelines for RIS care.