Overview
Radiologically isolated syndrome (RIS) is characterized by the incidental discovery of brain lesions suggestive of demyelination on neuroimaging in individuals who have not experienced any clinical symptoms of multiple sclerosis (MS) 1. It represents a preclinical stage of MS 1.Diagnosis
Diagnosis is based on the presence of incidental brain lesions suggestive of demyelination on MRI in the absence of clinical symptoms 1.Management
Disease-modifying treatments (DMTs) are associated with a lower risk of a clinical demyelinating event in individuals with RIS 1.
DMT treatment was associated with a lower risk of a clinical demyelinating event (adjusted hazard ratio=0.37, 95% CI: 0.15-0.95) 1.
There was a higher rate of adverse events in DMT-treated patients with RIS versus placebo (risk ratio=1.44, 95% CI: 1.09-1.90) 1.
Two randomized controlled trials (RCTs) evaluated teriflunomide or dimethyl fumarate versus placebo in RIS patients, with follow-up of at least 96 weeks 1.Key Recommendations
Disease-modifying treatments (DMTs) are associated with a lower risk of a clinical demyelinating event in individuals with RIS 1. (Evidence: Moderate)
DMT treatment in RIS is associated with a higher rate of adverse events compared to placebo 1. (Evidence: Moderate)References
1 Ripsman D, Tremlett H, Alzahrani A, Makhani N. Disease modifying treatment of radiologically isolated syndrome: A systematic review of the use, efficacy, effectiveness, and safety. Revue neurologique 2025. link