Radiologically isolated syndrome is captured when someone has a scan and when they get the scan back, it looks like MS. This study looks at the length of time it took for the MS to show itself, this occurred in about half the cases. Should we treat at that time. If it was something you have to take all the time I would not do it would you. however if offered a shot of cladribine as a one off in the hope it reduces the 50% risk, I may have a good think about it. Alemtuzumab a good treatment but it comes with too much baggage for this option and it would not fit the NHS criteria….This is one of the reasons why the Australians have got it some much more right than the UK, in that the state does not shackle its Neurologists. In the COVID era cladribine could have been a great option for the high efficacy drug options, 10 weeks at home even if you weren’t vulnerable, you could have drug delivered by Courier, no hospital visits, very limited monitoring. But no….inflexible NHS England and the ABN with blinkers, destining people onto CRABS and you know what I think about them…..right….I try not to think about them:-). Remember I’m not a neuro so I don’t have to think about them.
Radiologically Isolated Syndrome: 10-Year Risk Estimate of a Clinical Event.Lebrun-Frenay C, Kantarci O, Siva A, Sormani MP, Pelletier D, Okuda DT; 10-year RISC study group on behalf of SFSEP, OFSEP.Ann Neurol. 2020 Jun 4. doi: 10.1002/ana.25799. Online ahead of print.
Objective: We have previously identified male sex, younger age, and the presence of spinal cord lesions as independent factors that increase the 5-year risk for evolution from radiologically isolated syndrome (RIS) to multiple sclerosis. We investigate here risk factors for the development of a clinical event using a 10-year, multi-national, retrospectively-identified RIS dataset.
Methods: RIS subjects were identified according to 2009 RIS criteria and longitudinally followed as part of a worldwide cohort study. We analyzed data from 21 individual databases from 5 different countries. Associations between clinical and MRI characteristics, and the risk of developing a first clinical event were determined using multivariate Cox regression models.
Results: Additional follow-up data was available in 277/451 RIS subjects (86% female). Mean age at RIS diagnosis was 37.2 y (range:11-74 y) with a median clinical follow-up of 6.7 years. The cumulative probability of a first clinical event at 10 years was 51.2%. Age, positive CSF, infratentorial lesions on MRI, and spinal cord lesions, were baseline independent predictors associated with a subsequent clinical event. The presence of gadolinium enhancing lesions during follow-up was also associated with the risk of a seminal event. Reason for MRI and gadolinium enhancing lesions at baseline did not influence the risk of a subsequent clinical event.
Interpretation: Approximately half of individuals with RIS experience a first clinical event within 10 years of the index MRI. The identification of independent predictors of risk for symptom onset may guide education and clinical management of individuals with RIS