RIS: just incidental MRI findings or a real disease entity?
ECTRIMS Online Library. Okuda D. 09/13/19; 279555; 294
Darin Okuda
Darin Okuda
Contributions
Abstract

Abstract: 294

Type: Educational Session

Abstract Category: Educational Session 23: Radiologically Isolated Syndrome (RIS): inci

D.T. Okuda

University of Texas Southwestern Medical Center, Dallas, TX, United States

Specialists in neuroimmunology are frequently asked to provide clinical impressions on patients with MRI anomalies within the central nervous system (CNS). At times, healthy individuals, without clinical signs related to inflammatory demyelinating events, undergo structural neuroimaging for reasons other than for the evaluation of historical or recent symptoms related to MS. When white matter anomalies are identified, the observed features are more commonly suggestive of non-specific white matter (NSWM) disease, however, in rare instances features typical of in situ demyelination are recognized based on size, location, and spatial dissemination characteristics. These imaging features provide supportive evidence to para-clinical studies that may suggest injury related to aberrant immune behavior (i.e. presence of unique oligoclonal bands, etc.). The accurate recognition of individuals with radiologically isolated syndrome (RIS) provides a remarkable opportunity to understand the biology of disease. The existing criteria for MS 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. Retrospective multi-national data revealed that age, sex, and the presence of asymptomatic spinal cord lesions alone or in combination may increase risk for a first acute attack or the development of an initial neurological symptom with associated progression, fulfilling criteria for primary progressive multiple sclerosis. Imaging in RIS support early neurodegenerative features within thalami, cortical involvement, brain metabolic changes indicative of axonal damage, central vein characteristics in lesions, and retinal degenerative features. The entity has also been recognized in children. This presentation provides a comprehensive overview of RIS, the challenges faced by healthcare providers when evaluating patients with abnormal MRI studies, NSWM disease, recent scientific data aimed at improving the specificity of CNS white matter lesions, and insights into future investigations in this at risk group for future demyelinating events.
Disclosure: Dr. Okuda received personal compensation for consulting services and advisory board activities from Celgene, EMD Serono, Genzyme, and Novartis along with research support from Biogen.

Abstract: 294

Type: Educational Session

Abstract Category: Educational Session 23: Radiologically Isolated Syndrome (RIS): inci

D.T. Okuda

University of Texas Southwestern Medical Center, Dallas, TX, United States

Specialists in neuroimmunology are frequently asked to provide clinical impressions on patients with MRI anomalies within the central nervous system (CNS). At times, healthy individuals, without clinical signs related to inflammatory demyelinating events, undergo structural neuroimaging for reasons other than for the evaluation of historical or recent symptoms related to MS. When white matter anomalies are identified, the observed features are more commonly suggestive of non-specific white matter (NSWM) disease, however, in rare instances features typical of in situ demyelination are recognized based on size, location, and spatial dissemination characteristics. These imaging features provide supportive evidence to para-clinical studies that may suggest injury related to aberrant immune behavior (i.e. presence of unique oligoclonal bands, etc.). The accurate recognition of individuals with radiologically isolated syndrome (RIS) provides a remarkable opportunity to understand the biology of disease. The existing criteria for MS 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. Retrospective multi-national data revealed that age, sex, and the presence of asymptomatic spinal cord lesions alone or in combination may increase risk for a first acute attack or the development of an initial neurological symptom with associated progression, fulfilling criteria for primary progressive multiple sclerosis. Imaging in RIS support early neurodegenerative features within thalami, cortical involvement, brain metabolic changes indicative of axonal damage, central vein characteristics in lesions, and retinal degenerative features. The entity has also been recognized in children. This presentation provides a comprehensive overview of RIS, the challenges faced by healthcare providers when evaluating patients with abnormal MRI studies, NSWM disease, recent scientific data aimed at improving the specificity of CNS white matter lesions, and insights into future investigations in this at risk group for future demyelinating events.
Disclosure: Dr. Okuda received personal compensation for consulting services and advisory board activities from Celgene, EMD Serono, Genzyme, and Novartis along with research support from Biogen.

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