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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAlthough 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. \u003Cem\u003ECurr Neurol Neurosci Rep\u003C\/em\u003E 2011].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ENeuroimaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeuroimaging Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMagnetic Resonance Imaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDemyelinating Diseases\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe 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. \u003Cem\u003ECurr Neurol Neurosci Rep\u003C\/em\u003E 2011], a condition called radiologically isolated syndrome (RIS) [Okuda DT et al. Neurology 2009].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe natural course of RIS is largely unknown [De Stefano N et al. \u003Cem\u003EPloS One\u003C\/em\u003E 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. \u003Cem\u003ECurr Neurol Neurosci Rep\u003C\/em\u003E 2011]. D. Bartko, MD, Central Military Hospital, Ruzomberok, Slovak Republic, presented a poster that addressed this conundrum in a case report.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe patient was a 17-year-old female with uncertain vision problems. The ophthalmologist\u0027s 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.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EA 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\/mm\u003Csup\u003E3\u003C\/sup\u003E. No oligoclonal bands were observed. The IgG index was normal. VEP, BAEP, and SEP were repeatedly normal.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EDespite 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.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EProf. Bartko concluded that dissemination on MRI without clinical symptoms is not MS, and therefore, should not be treated.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/2\/9.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzni61\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}