Tuesday, 30 July 2013

Radiologically Isolated Syndrome..Real or a Red Herring

Gabelic T, Ramasamy DP, Weinstock-Guttman B, Hagemeier J, Kennedy C, Melia R, Hojnacki D, Ramanathan M, Zivadinov R. Prevalence of Radiologically Isolated Syndrome and White Matter Signal Abnormalities in Healthy Relatives of Multiple Sclerosis Patients.AJNR Am J Neuroradiol. 2013 Jul 25. [Epub ahead of print]

BACKGROUND AND PURPOSE:The exact prevalence of WM signal abnormalities in healthy relatives of MS patients and their impact on disease development has not been fully elucidated. The purpose of this study was to compare WM signal abnormality characteristics and the prevalence of radiologically isolated syndrome in healthy control subjects selected randomly from the population with the healthy relatives of patients with MS.
MATERIALS AND METHODS:Healthy control subjects (n = 150) underwent physical and 3T MR imaging examinations. Healthy control subjects were classified as non-familial healthy control subjects (n = 82) if they had no family history of MS or as healthy relatives of patients with MS (n = 68) if they had ≥1 relative affected with MS. The presence of radiologically isolated syndrome was evaluated according to the Okuda criteria; dissemination in space on MR imaging and fulfillment of radiologically isolated syndrome criteria were also evaluated according to Swanton criteria.
RESULTS: There was a significantly higher total volume of WM signal abnormality in the healthy relatives of patients with MS compared with the non-familial healthy control subjects (P = .024 for signal abnormality ≥3 mm in size and P = .025 for all sizes). Periventricular localization and the number of lesions in all groups (P = .034 and P = .043) were significantly higher in the healthy relatives of patients with MS; 8.8% of the healthy relatives of patients with MS and 4.9% of non-familial healthy control subjects showed ≥9 WM signal abnormalities; 2.9% of subjects in the healthy relatives of patients with MS group and 2.4% of non-familial healthy control subjects fulfilled radiologically isolated syndrome according to the Okuda criteria, whereas 10.3% and 3.7% of subjects fulfilled radiologically isolated syndrome according to the Swanton criteria. In the healthy relatives of patients with MS, smoking was associated with the presence of WM signal abnormalities, whereas obesity was related to the presence of ≥9 WM signal abnormalities and to fulfillment of radiologically isolated syndrome according to the Swanton criteria.
CONCLUSIONS:The frequency of WM signal abnormalities and radiologically isolated syndrome is higher in the healthy relatives of patients with multiple sclerosis patients compared with non-familial healthy control subjects.

3% of healthy sample had radiological abnormalities, but only 0.1% of the population get MS. Therefore what does it say about what the MRI is really detecting. Maybe time to revisit radiologically isolated syndrome criteria as 3% of this sample may now be worried and could mean that people could be getting unnecessary treatment if one was to start treating at RIS.

5 comments:

  1. That is a useful graph - is the depiction of inlammation reducing over time accurate (or thought to be)?
    Thanks

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    1. The number of relapses and MRI lesions goes down with age and time. Whether or not this reflects what is happening at a pathological level is a moot point. We know that at post-mortem the brains of SPMSers and PPMSers are stuffed full of inflammatory cells. This is why I think we need to treat progressive MS with anti-inflammatories and neuroprotective drugs.

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  2. Is there any anti-inflammatories available that SPMS and PPMSers can take? (in the UK)

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    1. If you have early SPMS and are still having relapses you may still be eligible for interferon-beta or mitoxantrone. You have to realise that when you make the call of someone being the SPMS phase or not is a grey area. Unfortunately, there is nothing licensed for PPMS. However, if you have PPMS and are less than 50 years of age and have Gd-enhancing lesions on your MRI I am prepared to make the case of treating you with Rituximab, based on the phase 2 trial results. However, with the NHS tightening its belt I suspect this option will disappear very soon.

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  3. How many other people have been diagnosed with MS - because of positive MRI and Spinal Tap findings, but who have NEVER had a relapse (as defined as an event that last for at least 24 hours)?

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