The availability of magnetic resonance imaging (MRI) has led to an increase in the detection of abnormal brain findings even in cases when there are no clear neurological symptoms. When these findings are similar to what is recognized in patients with multiple sclerosis (MS), but the patient is not experiencing any of the typical physical or neurological symptoms associated with MS, this is known as radiologically isolated syndrome (RIS). On the other hand, clinically isolated syndrome (CIS) refers to the first clinical CNS demyelinating event lasting longer than 24 hours, which is consistent with MS but is isolated in time and may or may not be isolated in space.
What is the pathophysiological difference between these two entities?
If to speak about really and radiologically isolated syndrome, that is, the presence of typical MRI picture of multiple sclerosis in the absence of any clinic, the main difference between CIS and RIS, in my opinion, is the localization of lesion in the strategically important (clinically relevant) and unimportant areas of the brain, respectively.
I am appreciated for your kind comments.
The therapeutic strategies against CIS and RIS are different each other?
I wonder how percentage of patients of CIS and RIS develop definitive multiple sclerosis, respectively.
The difference is that: CIS - must has a single clinical episode and typical MRI picture of multiple sclerosis ; RIS - we see typical MRI picture of multiple sclerosis without any clinical or spesial anamnesis of MS
According to the American approach - the therapy should begin when diagnosis of activity according to MRI at the stage of RIS.According to European recommendations - start therapy only when the transition to multiple sclerosis
Dr Yoshida, the more neurlogists and neuroradiologists you ask your two well-founded question the more different answers you will get. You need to ask a consortium of well established MS researchers to attain an agreement on these two points ... at least for some time. It were great if you might give the first public comment on my medium blogs on this point or ponder
https://medium.com/@franzschelling/what-deals-the-brain-such-blows-synchronous-at-least-double-hits-in-an-exemplary-case-of-292877844500
Late congratulations to your intriguing twin of questions, Dr. Yoshida!
Doesn't the "very individual" apply as much to the prescriber as to the one who complies with the prescription of a DMD, Mustafa Ali Khan?
Aren't treatment indications derived from non-specific signal-intense lesion burdens and enhancements nipping in the bud any attempt at ending a process of MS in eliminating its cause?
I am deeply appreciated for all the above great comments!
The positive ratio of oligoclonal band (OB) in CIS has been reported to be 46-75% according to the literature (Neurology 2008;70:1079-1083.). OB is a promising marker to predict CIS whether the patients can develop definite MS. Among the patients who do not have the demyelinated lesions in the brain, approximately 20% of the patients develop into clinically definite MS. It is highly likely that the normal-appearing white matter (NAWM) of MS patients should be carefully monitored not only by high resolution [7-tesla] MRI, but also proton MR spectroscopy which enables us to investigate into the metabolic change in NAWN (Hum Brain Mapp. 2017;38:4047-4063.).
When we check an activity or progression of RIS - it is not an indication of being diagnosed MS (this does not meet the criteria of the diagnosis). Currently, many supporters began therapy at the stage of RIS. But we have to prescribe drugs according to the instructions. In the instructions no RIS.
La esclerosis múltiple
mejor dicho el espectro de la EM significa que ella es un sindrome o una patologia heterogénea que tiene varios fenotipos ( Síndrome clínicamente aislado,(CIS), EM recaída remisión,EM secundaria progresiva y EM primariaprogresiva) , diferencia con Síndrome Radiologicamente aislado (RIS) : que este NO se considera un fenotipo de EM. En RIS NO hay clínica de EM o de CIS. CIS es el primer ataque por inflamacion de la mielina de una probable EM ,en RIS no hay ataques solo imágenes incidentales sugestivas de EM
CIS típico monofocal sugestivo de EM tiene sintoma y evidencia clínica de una lesion y puede ser de alto riesgo de conversión si tiene en la primera resonancia diseminacion en el espacio y merece tratamiento para retrasar la conversión a EM ya sea por un 2do ataque o nuevas imágenes en una resonancia de control . El tratamiento de estos CiS tiene su sustento en estudios CHAMPS (con interferon beta 1 a 30mg ) estudio BENEFIT(con interferon beta 1b 250mcg), estudio REFLEX con interferon beta 1a 44mcg) y /o con Teriflunamida oral 14 mg estudio TOPiC.
Un 35 % de los CIS son EM de entrada pues en la primera resonancia hay diseminación en el espacio y en el tiempo y por supuesto también son tratables y ademas indican el comienzo de una EM más agresiva.
Todo lo anterior NO ocurre en los RIS donde también hay RIS con mayor riesgo de conversión a EM pues tienen imágenes que captan gadolinio
(Indica inflamaciion),o tienen LCR con bandas oligoclonales o tienen imagenes también asintomaticas en medula espinal . A pesar de esto nohay fuerte evidencia o recomendación de que deban tratarse. (Comité MAGNIMS 2016) Si un profesional los trata es una decisión individual pero con poco fundamento. La pregunta también que surge es si un colega empieza a tratar un RIS con qué terapia modificadora de la enfermedad o droga empieza ?.Gracias por establecer esta polémica crucial yun saludo afectuoso a todos
Roberto Rotta Escalante. Buenos Aires Argentina
Sabran disculparme pero en el comentario que me solocitaron hacer (diferencias entre RIS y CIS ) omiti mencionar que en los CIS con alto riesgo de conversión a EM hay otra droga que ha demostrado retrasar la conversión a EM y que es el acetato de glatiramer 20mg (estudio PRECISE)
Saludos cordiales
R. Rotta Escalante
Dr. Escalante,
what about defining MS instead of by ever new neurological conventions by specific physical findings? As shown by the archetypal illustrations ending www.ms-info.net and all the corresponding MRI pictures, there exist more than enough pieces of an MS-specific morphological evidence which only wait to be explored.
Best wishes, also to all those who suffer from the observational deficiencies and rational incosistencies of MS research,
Franz Schelling
For the treatment of clinically isolated syndrome were studied some drugs, but for the radiologically isolated syndrome - no
Please, Dr. Popova, what speaks against defining MS instead of by convened on clinical SYNDROMES by MS-specific physical (autoptic, imaging) FACTS?
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