Contributions
Abstract: 154
Type: Oral
Central nervous system (CNS) demyelination resulting from misbehavior of the immune system may be best described as a 'silent thief', slowly stealing proper neuronal and cellular functions and only becoming apparent when a threshold for symptom manifestation is exceeded. The accurate recognition of individuals with radiologically isolated syndrome (RIS) provides a remarkable opportunity for the early introduction of disease modifying therapy (DMT) to extend the time to or prevent the development of an initial clinical inflammatory event, further radiological evolution, and future physical disability resulting from advancing in situ demyelination. These individuals are asymptomatic for clinical experiences specific to multiple sclerosis (MS) and their brain MRI study data reveal incidentally identified anomalies that are highly suggestive of CNS autoimmune injury based on lesion size, number, and spatial dissemination. The existing diagnostic criteria recognize that these individuals may be appreciated in clinical practice and that they are at likely risk for MS depending on the evolution of neurological symptoms and signs. Previous scientific data demonstrated that RIS subjects are at risk for new MRI inflammatory demyelinating events within the brain and spinal cord. In addition, features supportive of early neurodegeneration, specifically thalamic atrophy, have been described prior to first symptom development associated with CNS demyelination. Beyond risks for new MRI activity, these individuals are also susceptible to future acute clinical exacerbations with increased probabilities linked to age, sex, and area of involvement within the CNS and insidious symptom development followed by neurological progression, fulfilling criteria for primary progressive MS. This presentation provides a rationale to support the stance for the use of DMT in the treatment of RIS subjects, a preventive management strategy utilized in all other MS subtypes and one that is aimed at reducing the probability of future disability while simultaneously preserving quality of life outcomes.
Disclosure: D.O. received lecture fees from Acorda Therapeutics, Genentech, Genzyme, and Teva, advisory and consulting fees from EMD Serono, Genentech, Genzyme, and Novartis and research support from Biogen.
Abstract: 154
Type: Oral
Central nervous system (CNS) demyelination resulting from misbehavior of the immune system may be best described as a 'silent thief', slowly stealing proper neuronal and cellular functions and only becoming apparent when a threshold for symptom manifestation is exceeded. The accurate recognition of individuals with radiologically isolated syndrome (RIS) provides a remarkable opportunity for the early introduction of disease modifying therapy (DMT) to extend the time to or prevent the development of an initial clinical inflammatory event, further radiological evolution, and future physical disability resulting from advancing in situ demyelination. These individuals are asymptomatic for clinical experiences specific to multiple sclerosis (MS) and their brain MRI study data reveal incidentally identified anomalies that are highly suggestive of CNS autoimmune injury based on lesion size, number, and spatial dissemination. The existing diagnostic criteria recognize that these individuals may be appreciated in clinical practice and that they are at likely risk for MS depending on the evolution of neurological symptoms and signs. Previous scientific data demonstrated that RIS subjects are at risk for new MRI inflammatory demyelinating events within the brain and spinal cord. In addition, features supportive of early neurodegeneration, specifically thalamic atrophy, have been described prior to first symptom development associated with CNS demyelination. Beyond risks for new MRI activity, these individuals are also susceptible to future acute clinical exacerbations with increased probabilities linked to age, sex, and area of involvement within the CNS and insidious symptom development followed by neurological progression, fulfilling criteria for primary progressive MS. This presentation provides a rationale to support the stance for the use of DMT in the treatment of RIS subjects, a preventive management strategy utilized in all other MS subtypes and one that is aimed at reducing the probability of future disability while simultaneously preserving quality of life outcomes.
Disclosure: D.O. received lecture fees from Acorda Therapeutics, Genentech, Genzyme, and Teva, advisory and consulting fees from EMD Serono, Genentech, Genzyme, and Novartis and research support from Biogen.