Summary
Although disease-modifying therapies work best when given early in MS, the decision to proactively treat patients with radiologically isolated syndrome (RIS) is countered by the increasing risks associated with disease-modifying therapies as well as the uncertain prognostic outcome of RIS [Spain R, Bourdette D. Curr Neurol Neurosci Rep 2011].
- Neuroimaging
- Neuroimaging Clinical Trials
- Magnetic Resonance Imaging
- Demyelinating Diseases
The wide use of magnetic resonance brain imaging has led to the unexpected detection of lesions that appear typical of multiple sclerosis (MS) in otherwise asymptomatic patients [Spain R, Bourdette D. Curr Neurol Neurosci Rep 2011], a condition called radiologically isolated syndrome (RIS) [Okuda DT et al. Neurology 2009].
The natural course of RIS is largely unknown [De Stefano N et al. PloS One 2011]. Although disease-modifying therapies work best when given early in MS, the decision to proactively treat patients with RIS is countered by the increasing risks associated with disease-modifying therapies as well as the uncertain prognostic outcome of RIS [Spain R, Bourdette D. Curr Neurol Neurosci Rep 2011]. D. Bartko, MD, Central Military Hospital, Ruzomberok, Slovak Republic, presented a poster that addressed this conundrum in a case report.
The patient was a 17-year-old female with uncertain vision problems. The ophthalmologist's diagnosis was uveitis. The neurologic examination was normal. The brain MRI showed abnormalities suggestive of MS (5 Gd-enhancing hyperintensities, periventricular involvement, and ovoid corpus callosum). Results were not consistent with a vascular pattern. Over 9 years, there were no clinical symptoms.
A new MRI showed 16 Gd-enhancing brain and cervical spinal cord hyperintensities, locations that are considered predictors for MS. Dissemination in space and time were noted. Cerebrospinal fluid had 3 cells/mm3. No oligoclonal bands were observed. The IgG index was normal. VEP, BAEP, and SEP were repeatedly normal.
Despite the high lesion load, the patient remained asymptomatic, with normal neurological examinations. Despite recommendations to treat individuals with spinal cord lesions, the authors chose a strategy of watchful waiting, with regular examinations and repeated cognitive testing.
Prof. Bartko concluded that dissemination on MRI without clinical symptoms is not MS, and therefore, should not be treated.
- © 2012 MD Conference Express®
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