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Hi all

In the FYI FWIW category, here's a link to a free full text article: Incidental demyelinating inflammatory lesions in asymptomatic patients: a Brazilian cohort with radiologically isolated syndrome and a critical review of the literature

Quoting from the intro to the article:

The term radiologically isolated syndrome (RIS) was recently introduced to describe patients who have incidental brain magnetic resonance imaging (MRI) abnormalities suggestive of multiple sclerosis (MS), but without any signs or symptoms attributable to the disease1.

The current literature has demonstrated that RIS patients may

develop clinical symptoms, converting to either relapsing-remitting or primary progressive MS3.

Alternatively, patients may show progression in the MRI lesions without any objective clinical symptoms (radiologic progression);

patients may even show stabilized brain abnormalities in subsequent imaging examinations1-6

Take care all

Sharon

thanks, Shayk. I think it's pretty relevant.
interesting to note that these patients had normal neuro exams upon presentation with lesions. Now that MRI is more routinely utilized in migraine, depression, neurovascular disease diagnosis --we'll probably see more of this.

Patient ages ranged from 17 to 54 years, with a median age of 38.7 years (standard deviation of 9.5 years). The median follow-up period for these patients was 49.2 months (range 11-109 months). All patients had a normal neurological examination at the first MRI scan, without any familial history of MS.

Symptoms that led to the first MRI scan included primary headache (7/12-58.3%) and depression unrelated to a typical inflammatory-demyelinating CNS syndrome (2/12-16.7%). One patient reported hyperprolactinemia, while another patient had a pineal cyst previously observed on a computed tomography scan. One patient was being investigated for a long-lasting horizontal nystagmus (Table 2).

So, my doctor initially told me that I have RIS. I had an MRI for a severe headache when my BP was high. It showed two active lesions. My subsequent tests were all negative EXCEPT for the lumbar puncture which was positive for the oligoclonal bands (I think that's what they were called). The only symptom that I experienced was mild vertigo about 2 weeks before that (who knows if this was my episode or not). At that time he said that there were different thoughts on treating people with RIS before the onset of symptoms. I was in a bit of denial, believe it or not, and decided not to do the meds at that time. When I followed up a year later, my MRI did not show any new lesions, and the old lesions were no longer active. Amazingly at that time, my neuro recommended that I start interferon therapy. Apparently the studies were leaning more toward treating. So I started out with Rebif, but felt too tied down with 3 shots a week. Have been on Avonex for about 6 months and have been very pleased.

I'm in a similar situation, Jenny. A doc ordered an MRI for a hearing problem and the radiologist came back with a report saying my brain looked like it had MS. My first instinct was denial, second to take vitamin D in case it isn't too late. I had to figure out on my own that this is called RIS and that less than half of us get MS within 5 years.

No action from the docs yet. I didn't think I had any symptoms but I am a bit unbalanced when walking to the bathroom in the middle of the night and I can get terrible vertigo when working under a car looking straight up. Doc said this was due to some stones in my balance channels and it did respond to the maneuver for getting those stones to settle down. I'm hoping to dodge the bullet and very thankful I didn't get MS when younger. I live in a very high risk area - northern Alberta. I'm 60 now.

Anyone treating RIS? I was diagnosed a year ago after getting an MRI for a sports related injury and finding some unwanted legions. I've seen 3 neurologists and they all suggested I treat. I started on Avonex and whoever said "flu like symptom" needs to be slapped. I couldn't take being layed out for a day every week. Switched to Copaxone. I guess you can call me Mr. 3% since after my 3rd injection I got the night chills / muscle spasms and have been running hot.

Just wondering if there are any other RIS people out there - and if any of you have decided not to treat and how long you've been fine...

I'm thinking about stopping any DMT.

Thank you in advance!!!

aschameleon wrote:Anyone treating RIS? I was diagnosed a year ago after getting an MRI for a sports related injury and finding some unwanted legions. I've seen 3 neurologists and they all suggested I treat. I started on Avonex and whoever said "flu like symptom" needs to be slapped. I couldn't take being layed out for a day every week. Switched to Copaxone. I guess you can call me Mr. 3% since after my 3rd injection I got the night chills / muscle spasms and have been running hot.

Just wondering if there are any other RIS people out there - and if any of you have decided not to treat and how long you've been fine...

I'm thinking about stopping any DMT.

Thank you in advance!!!

I'm not RIS, but yes, Avonex side effects can be "difficult." Personally, I wouldn't take any of the DMTs without a confirmed MS diagnosis.

aschameleon wrote:Anyone treating RIS? I was diagnosed a year ago after getting an MRI for a sports related injury and finding some unwanted legions. I've seen 3 neurologists and they all suggested I treat. I started on Avonex and whoever said "flu like symptom" needs to be slapped. I couldn't take being layed out for a day every week. Switched to Copaxone. I guess you can call me Mr. 3% since after my 3rd injection I got the night chills / muscle spasms and have been running hot.

Just wondering if there are any other RIS people out there - and if any of you have decided not to treat and how long you've been fine...

I'm thinking about stopping any DMT.

Thank you in advance!!!

Have you had a vitamin D test? If so, do you know the results? If your vitamin D3 level is low, then raising it can have about the same efficacy as several of the CRAB drugs.

Pierrot-Deseilligny et al. 2012 reported that every 10 nmol/L increase in 25-OH-D level, up to 110 nmol/L, was associated with a reduction in the relapse incidence rate of 13.7%.

http://www.ncbi.nlm.nih.gov/pubmed/22783368

A mere 30 nmol/L increase in 25-hydroxy vitamin D3 puts it in the efficacy range of interferon beta1a with a 41% reduction in relapses. The side effects are nonexistent and the cost is spit in a hurricane in comparison.

Note: 110 nmol/L = 44.1 ng/mL. Divide by 2.496 to convert nmol/L to ng/mL.