Contributions
Abstract: 155
Type: Oral
The radiologically isolated syndrome (RIS) was first formally described in 2009 to characterize individuals who presented with brain magnetic resonance imaging (MRI) findings similar to those observed in patients with multiple sclerosis but who clinically had no suspicion of having multiple sclerosis (MS). This syndrome is rare and the cumulative incidence calculated from autopsic studies and actual registries from MRI centers agree to a calculation of 0.1%. Diagnostic criteria has been published in 2009 and risk factors for clinical conversion described as male gender, spinal cord lesion and young age. The diagnosis of radiologically isolated syndrome is delicate and should be carefully announced. The syndrome should be considered a diagnosis of exclusion rather than a default. Incidence of misdiagnoses increases in multiple sclerosis and its early stage, especially in RIS. Recents studies have shown that some patients were diagnosed as MS and under disease modifying therapies (DMT) without having any demyelinating disease. As the clinical disease course of MS is highly variable with the MRI lesion load remaining stable, the RIS course is unknown and the first clinical manifestation may never occur. Several RIS patients will not experience their initial clinical event and it is conceivable that these patients will never require treatment. Extensive screening is recommended and if the « wait and follow » rule is not observed, off-label treatment should not be proposed. Two phase III double-blind studies are conducted in US and EU evaluating either dimethylfumarate or teriflunomide in the time for presenting a clinical event. Excepted in a very controlled situation as a clinical study, given the available data on RIS patients, no definite recommendation can be made, since disease activity may remain silent over a longer period or even a lifetime. Other epidemiological studies are needed to better define prognostic factors and RIS patients who are requiring DMT.
Disclosure: CL has participated to advisory boards or conferences for Biogen, Merck, Genzyme, Novartis, Roche, Teva
Abstract: 155
Type: Oral
The radiologically isolated syndrome (RIS) was first formally described in 2009 to characterize individuals who presented with brain magnetic resonance imaging (MRI) findings similar to those observed in patients with multiple sclerosis but who clinically had no suspicion of having multiple sclerosis (MS). This syndrome is rare and the cumulative incidence calculated from autopsic studies and actual registries from MRI centers agree to a calculation of 0.1%. Diagnostic criteria has been published in 2009 and risk factors for clinical conversion described as male gender, spinal cord lesion and young age. The diagnosis of radiologically isolated syndrome is delicate and should be carefully announced. The syndrome should be considered a diagnosis of exclusion rather than a default. Incidence of misdiagnoses increases in multiple sclerosis and its early stage, especially in RIS. Recents studies have shown that some patients were diagnosed as MS and under disease modifying therapies (DMT) without having any demyelinating disease. As the clinical disease course of MS is highly variable with the MRI lesion load remaining stable, the RIS course is unknown and the first clinical manifestation may never occur. Several RIS patients will not experience their initial clinical event and it is conceivable that these patients will never require treatment. Extensive screening is recommended and if the « wait and follow » rule is not observed, off-label treatment should not be proposed. Two phase III double-blind studies are conducted in US and EU evaluating either dimethylfumarate or teriflunomide in the time for presenting a clinical event. Excepted in a very controlled situation as a clinical study, given the available data on RIS patients, no definite recommendation can be made, since disease activity may remain silent over a longer period or even a lifetime. Other epidemiological studies are needed to better define prognostic factors and RIS patients who are requiring DMT.
Disclosure: CL has participated to advisory boards or conferences for Biogen, Merck, Genzyme, Novartis, Roche, Teva