The Need for Guidelines on the Management of Radiologically Isolated Syndrome: Jiwon Oh, MD, PhD


The staff neurologist and medical director of the Barlo Multiple Sclerosis Program at St Michaels Hospital discussed the lack of guidelines for patients with RIS and the research efforts needed going forward to establish them.

WATCH TIME: 4 minutes

"It’s a tough sell telling a patient who feels fine that they need to be on a daily regular medication that potentially has side effects. We need phase 3 clinical trial data, and then we need better biomarkers to be able to say, ‘You need to be on treatment. Yes, these treatments have side effects, but it would be helpful for you because you are at a high risk of developing MS.’"

Radiologically isolated syndrome (RIS) is a neurological condition that is characterized by lesions in the central nervous system, specifically the brain, spinal cord, and optic nerves. Historically, RIS has been linked to multiple sclerosis (MS) because of similarities in how brain and spine scans may appear. Being diagnosed with RIS however, does not directly correlate with a diagnosis of MS. Before the introduction of MRI, incidental findings suggestive of MS were only encountered on autopsies, and even after being formally defined for the first time in 2009 by Darin T. Okuda, MD, et al,1,2 clinicians still are without answers as to why some cases of RIS do and don’t develop into MS.

Researchers including Jiwon Oh, MD, PhD, have thought to use RIS as a way to evaluate the earliest stages of MS, as MS pathophysiologic processes are known to start well before the first symptoms occur. Oh, who is a staff neurologist and medical director of the Barlo Multiple Sclerosis Program at St. Michaels Hospital at the University of Toronto, believes there needs to be an increased push to improve guidelines and management for these patients. Although the syndrome is not common, clinicians have typically taken a trial-and-error approach to treatment with close monitoring.

At the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2022, February 24-26, in West Palm Beach, Florida, Oh presented on the clinical value of imaging biomarkers within the RIS/MS prodrome. Among the many themes of her presentation, she summarized the current clinical management of RIS and how these biomarkers may be incorporated into routine clinical care. Following the meeting, Oh sat down with NeurologyLive® to discuss the need to implement new, up-to-date guidelines for this patient population. She also gave her thoughts on whether RIS is understudied and how it can lead to a greater understanding of MS.

1. Okuda DT, Mowry EM, Beheshtian A, et al. Incidental MRI anomalies suggestive of multiple sclerosis: the radiologically isolated syndrome. Neurology. 2009;72(9):800-805. doi:10.1212/01.wnl.0000335764.14513.1a
2. Nakamura M, Morris M, Cerghet M, et al. Longitudinal follow-up of a cohort of patients with incidental abnormal magnetic resonance imaging findings at presentation and their risk of developing multiple sclerosis. Int J MS Care. 2014;16(3):111-115. doi:10.7224/1537-2073.2013-016
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