Radiologically isolated syndrome: from biological bases to practical management

• Published in: Neurological sciences 2021-04, Vol.42 (4), p.1335-1344
• Main Authors: Barboza, Andres G., Carnero Contentti, Edgar, Curbelo, Maria Celeste, Halfon, Mario Javier, Rojas, Juan Ignacio, Silva, Berenice A., Sinay, Vladimiro, Tizio, Santiago, Ysrraelit, Maria Celica, Alonso, Ricardo
• Format: Article
• Language: English
• Subjects: Adult; Central nervous system; Cerebrospinal fluid; Demyelinating diseases; Demyelinating Diseases - diagnostic imaging; Demyelinating Diseases - therapy; Demyelination; Evoked Potentials, Visual; Humans; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Multiple sclerosis; Multiple Sclerosis - diagnostic imaging; Multiple Sclerosis - therapy; Neuroimaging; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Oligoclonal Bands; Psychiatry; Review Article; Visual evoked potentials
• ISSN: 1590-1874; 1590-3478
• DOI: 10.1007/s10072-021-05069-6

Background Technological advances and greater availability of magnetic resonance imaging have prompted an increment on incidental and unexpected findings within the central nervous system. The concept of radiologically isolated syndrome characterizes a group of subjects with images suggestive of demyelinating disease in the absence of a clinical episode compatible with multiple sclerosis. Since the description of this entity, many questions have arisen; some have received responses but others remain unanswered. Review summary A panel of experts met with the objective of performing a critical review of the currently available evidence. Definition, prevalence, biological bases, published evidence, and implications on patient management were reviewed. Thirty to 50% of subjects with radiologically isolated syndrome will progress to multiple sclerosis in 5 years. Male sex, age < 37 years old, and spinal lesions increase the risk. These subjects should be evaluated by a multiple sclerosis specialist, carefully excluding alternative diagnosis. An initial evaluation should include a brain and complete spine magnetic resonance, visual evoked potentials, and identification of oligoclonal bands in cerebrospinal fluid. Disease-modifying therapies could be considered when oligoclonal bands or radiological progression is present. Conclusion At present time, radiologically isolated syndrome cannot be considered a part of the multiple sclerosis spectrum. However, a proportion of patients may evolve to multiple sclerosis, meaning it represents much more than just a radiological finding.