EPI02
A Systematic Review of Signs and Symptoms Associated with Radiologically Isolated Syndrome That Are Suggestive of a Multiple Sclerosis Prodrome
Radiologically isolated syndrome (RIS) is typically identified when a magnetic resonance imaging (MRI) of the brain occurs for an indication unrelated to suspected demyelination, and lesions characteristic of multiple sclerosis (MS) are incidentally found. The reasons for obtaining the index MRI in RIS subjects may offer insights into the early signs and symptoms of demyelinating disease.
Objectives: ,
To conduct a systematic review to investigate the initial signs and symptoms prompting MRI investigation in RIS subjects.
Methods: ,
MEDLINE, EMBASE, Web of Science Core Collection and ClinicalTrials.gov were searched between Jan/1997 to Jun/2021. Eligible studies had to: report any sign/symptom prompting an MRI in persons found to have RIS; be published in English; and include original data. RIS diagnosis must have met 2009 Okuda criteria or fulfill the MRI criteria for dissemination in space appropriate for the study time. Study designs could include case reports, case series, case-control, observational or randomized controlled trials. Study screening was conducted by two independent authors.
Results: ,
Of 4055 studies identified, 61 were eligible. Of these, 50 were observational (40 longitudinal cohort, 5 cross-sectional, 1 case-control) and 15 were case reports/case series. Studies were performed in Europe (n=35), North America (n=17), Middle-East (n=15), and Latin America (n=4), including 5 multi-continental studies. No studies from Asia/Pacific and Africa were identified. In total, 1604 RIS subjects were included; 1210 of whom (75.4%) were women. Overall, 1629 reasons for an MRI were collected from 1604 RIS participants. The most common were: headache/migraine (763/1629; 46.8%); neurological symptoms not attributed to demyelination (129; 7.9%) e.g., epilepsy, atypical sensory and motor symptoms; eye, ear, nose or throat complaints (86; 5.3%); psychiatric symptoms (77; 4.7 %) e.g., anxiety and depression; and vertigo/dizziness (74; 4.5%). In total, 206 (12.6%) of MRIs were not performed for a specific sign/symptom; instead, reasons included trauma, routine medical screening/follow-up, family history of MS and being a control participant in a study.
Conclusions: .
This systematic review provides a comprehensive summary evaluating the range of signs and symptoms prompting the initial MRI in persons with RIS. Future work will evaluate whether these sign/symptoms differed between RIS patients who either were, or were not, subsequently diagnosed with MS.