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Radiologically isolated syndrome: from biological bases to practical management

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Abstract

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.

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Funding

Irrestrictive research grant from Novartis Argentina allowed the development and implementation of the project.

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Authors and Affiliations

  1. Servicio de Neurologia, Hospital Central de Mendoza, España 120, 5500, Mendoza, Argentina

    Andres G. Barboza

  2. Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina

    Edgar Carnero Contentti

  3. MS Section Hospital Britanico Buenos Aires, Buenos Aires, Argentina

    Maria Celeste Curbelo & Mario Javier Halfon

  4. Hospital Municipal de Vicente López Prof. Dr. Bernardo Houssay, Buenos Aires, Argentina

    Mario Javier Halfon

  5. Centro de Esclerosis Múltiple de Buenos Aires, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Juan Ignacio Rojas

  6. Clínica de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina

    Berenice A. Silva & Ricardo Alonso

  7. Fundación Favaloro/INECO, Buenos Aires, Argentina

    Vladimiro Sinay

  8. Hospital Español de La Plata, La Plata, Argentina

    Santiago Tizio

  9. Department of Neurology, Institute for Neurological Research Dr. Raul Carrea, FLENI, Buenos Aires, Argentina

    Maria Celica Ysrraelit

  10. Sanatorio Guemes, Buenos Aires, Argentina

    Ricardo Alonso

Authors
  1. Andres G. Barboza
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  2. Edgar Carnero Contentti
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  3. Maria Celeste Curbelo
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  4. Mario Javier Halfon
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  5. Juan Ignacio Rojas
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  6. Berenice A. Silva
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  7. Vladimiro Sinay
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  8. Santiago Tizio
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  10. Ricardo Alonso
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Corresponding author

Correspondence to Andres G. Barboza.

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Conflict of interest

AGB has received reimbursement for developing educational presentations, educational and research grants, consultations fees, and travel stipends from Biogen, Genzyme, Novartis, TEVA, Tuteur, Gador, Raffo, Biosidus, Synthon – Bagó, and Roche.

ECC has received professional travel accommodation stipends from Merck-Serono, TEVA, Genzyme, Biogen-Idec, and Novartis. ECC has also received reimbursement for developing educational presentations from Merck-Serono, Genzyme, Biogen-Idec, Roche, and Novartis as well as grants for research from Novartis, Bayer, and Merck-Serono.

MCC works as a medical scientific liaison for Novartis, Argentina.

MJH has received professional travel accommodation stipends from Biogen-Idec, Novartis, Genzyme, Gador, Roche, TEVA, and Merck-Serono. MJH has also received reimbursement for educational presentations from Biogen-Idec, Genzyme, and Novartis as well as grants for research from Novartis and Genzyme.

BAS has received economic retribution for the development of educational, scientific activities and travel grants to Congresses from Biogen, Novartis, Merck, Genzyme, and TEVA.

VS has received reimbursement for developing educational presentations, educational and research grants, consultations fees, and travel stipends from Bayer, Biogen, Genzyme, Merck, Novartis, Roche, Biosidus, Gador, and Raffo.

ST has received professional travel accommodation stipends from Merck-Serono, Synthon Bago, Biogen-Idec, TEVA, Genzyme, Novartis, and Roche. ST has also received reimbursement for developing educational presentations from Biogen-Idec and Novartis.

MCY has received reimbursement for developing educational presentations and travel/accommodations stipends from Merck-Serono Argentina, Biogen-Idec Argentina, Genzyme Argentina, Bayer Inc., Novartis Argentina, and TEVA-Tuteur Argentina.

RA has received professional travel accommodation stipends from Merck, Synthon Bago, Biogen-Idec, Novartis, and Roche. RA has also received reimbursement for developing educational presentations from Genzyme, Biogen-Idec, Roche, and Novartis.

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Barboza, A.G., Carnero Contentti, E., Curbelo, M.C. et al. Radiologically isolated syndrome: from biological bases to practical management. Neurol Sci 42, 1335–1344 (2021). https://doi.org/10.1007/s10072-021-05069-6

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