Behind this somewhat cumbersome term “Radiologically Isolated Syndrome (RIS)” lies a situation that is increasingly common in our technologically advanced medical world and is then associated with a great deal of uncertainty – one could speak of a real dilemma.This refers specifically to the following situation: An individual goes to the doctor because of headaches. During his examination, the doctor does not find anything serious and assumes it is a simple migraine or tension headache, but still suggests – also to protect himself – to perform an MRI scan of the head – “so that nothing is overlooked”. Yes, and then this scan, which was actually supposed to relieve both parties, unexpectedly shows significant abnormalities, the typical white spots, as they are also found in MS. But the affected person assures that they have never had any symptoms that remind of MS. The “problem” can therefore only be detected radiologically – “radiologically isolated” so to speak.
Overall, this is a very difficult situation, especially for the person affected. Because suddenly a healthy young person is confronted with the possibility of a chronic disease – with all the fears and worries associated with it. Also a dilemma for us neurologists, because we want to treat disease symptoms and not technical findings. So how to deal with such findings? Ignore or take them seriously and possibly seek treatment?
There is a scientific analysis of this problem that can help answer these questions. Prof. Darin Okuda from the University of Dallas has collected data from a total of 450 patients with a typical “Radiologically Isolated Syndrome (RIS)” and observed the people over the long term (Okuda DT et al., PLoS One. 2014 Mar 5;9(3):e90509). He was able to show that after five years about one third of people with RIS had suffered a disease flare-up, after ten years, according to the latest data, this was the case for about half of people. Later disease symptoms occurred especially in young men with spinal cord lesions. If such a constellation is present, one could consider starting therapy based on the data.
Nevertheless, many MS experts generally see no reason for MS therapy in a radiologically isolated syndrome, because an imaging finding does not unequivocally indicate MS pathology. Therefore, I usually recommend a wait-and-see approach, even though this is a real test for the person affected. Positive support is then very important, among other things, it can also be seen as a chance that one was alerted to a health problem at the earliest possible stage (although I believe that most of those affected would have preferred to do without this information).
I consider it very important to take a thorough medical history of people with RIS, because in many cases symptoms can be traced back in the past that are typical for MS. In such a case, the further procedure is also much more clear. Therefore, we doctors rely heavily on the cooperation of our patients, so that we really get all relevant information. In the end, a supposed “herniated disc” or a “tension” turns out to be clinical symptoms of MS. Therefore, when taking a medical history, always tell what you have experienced yourself – and not what the “treater” has interpreted from it in the past. And one more thing RIS teaches us – you don’t have to have an MRI done for every little thing…..
