Navigating the Decision to Treat Multiple Sclerosis Early Versus Later: Mikael Cohen, MD

WATCH TIME: 3 minutes

“Trying to detect early neurodegeneration in at-risk populations could be one step forward.”

Previous research has defined radiologically isolated syndrome (RIS) as the incidental discovery of MRI lesions indicative of multiple sclerosis (MS) in patients who underwent an MRI for an unrelated issue and showed normal neurological examination results. While some recent studies have suggested that subtle abnormalities can be detected in MS patients with an Expanded Disability Status Scale of 0 using more complex tasks than traditional exams, there has been limited evidence regarding the RIS population.

A recent study presented at the 2024 European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) Congress, September 18-20, in Copenhagen, Denmark, demonstrated the value of digital tools in detecting subtle neurological abnormalities in RIS patients compared to healthy controls. Led by Mikael Cohen, MD,a neurologist at the MS Center at the University Hospital Center of Nice in France, and colleagues, these findings highlighted how fast and efficient digital tools can identify abnormalities in patients with normal traditional neurological exams, indicating that such digital assessments could be useful in other neurological conditions as well.

Cohen also contributed to a hot topic session at the Congress titled “Prodromal MS and Radiologically Isolated Syndromes,” where he discussed whether RIS is an early form of presymptomatic MS. During the event, Cohen sat down with NeurologyLive^® for an interview, where he shared insights on how clinicians approach treatment decisions in patients with low lesion loads and few risk factors for conversion to MS. He also discussed the next steps in research needed to better understand early neurodegenerative processes that may occur before the first lesions appear on MRI. Additionally, Cohen reflected on managing patient concerns when considering whether to adopt a "wait and see" strategy or initiate early disease-modifying therapy.

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REFERENCES
1. Cohen M, et al. Exploring the radiologically isolated syndrome through digital biomarkers: what’s the real definition of a normal neurological examination? normal neurological examination?. Presented at: 2024 ECTRIMS; September 18-20; Copenhagen, Denmark. Abstract P288.