Radiologisch isoliertes Syndrom: Verlauf und Empfehlungen zum klinischen Management

Zusammenfassung

Die Problematik der frühestmöglichen Diagnosestellung der Multiplen Sklerose (MS) wird anhand einer Patientin illustriert, bei der zunächst ein radiologisch isoliertes Syndrom (RIS) diagnostiziert wurde. Im weiteren Verlauf manifestierte sich ein klinisches Schubereignis (klinisch isoliertes Syndrom, KIS). Die diagnostischen und therapeutischen Aspekte werden jeweils im Kontext mit der aktuellen Datenlage und den 2010 revidierten McDonald-Kriterien zur Diagnosestellung der MS diskutiert.

Abstract

The complex of problems associated with the early diagnosis of multiple sclerosis (MS) is illustrated by the case of a patient in whom the diagnosis of a radiologically isolated syndrome (RIS) was made and who later on developed a clinically isolated syndrome (CIS). Aspects of diagnosis and treatment are discussed with respect to available clinical data and the 2010 revision of the McDonald criteria for the definition and diagnosis of MS.

Schlüsselwörter

radiologisch isoliertes Syndrom - klinisch isoliertes Syndrom - Diagnose der Multiplen Sklerose - Therapiebeginn

Keywords

radiologically isolated syndrome - clinically isolated syndrome - diagnosis of multiple sclerosis - onset of therapy

• Literatur

• 1 de Seze J, Lanctin C, Lebrun C et al. Idiopathic acute transverse myelitis: application of the recent diagnostic criteria. Neurology 2005; 65: 1950-1953
• 2 Bourdette D, Simon J. The radiologically isolated syndrome: is it very early multiple sclerosis?. Neurology 2009; 72: 780-781
• 3 Zettl UK, Stüve O, Patejdl R. Immune-mediated CNS diseases: A review on nosological classification and clinical features. Autoimmun Rev 2012; 11: 167-173
• 4 Barkhof F, Filippi M, Miller DH et al. Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis. Brain 1997; 120: 2059-2069
• 5 Lebrun C, Bensa C, Debouverie M et al. Association between clinical conversion to multiple sclerosis in radiologically isolated syndrome and magnetic resonance imaging, cerebrospinal fluid, and visual evoked potential: follow-up of 70 patients. Arch Neurol 2009; 66: 841-846
• 6 Okuda DT, Mowry EM, Beheshtian A et al. Incidental MRI anomalies suggestive of multiple sclerosis: the radiologically isolated syndrome. Neurology 2009; 72: 800-805
• 7 Okuda DT, Mowry EM, Cree BAC et al. Asymptomatic spinal cord lesions predict disease progression in radiologically isolated syndrome. Neurology 2011; 76: 686-692
• 8 Sellner J, Schirmer L, Hemmer B et al. [Radiologically isolated syndrome: multiple sclerosis based solely on MRI findings?]. Nervenarzt 2010; 81: 1208-1217
• 9 Polman CH, Reingold SC, Banwell B et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011; 69: 292-302
• 10 Jacobs LD, Beck RW, Simon JH. CHAMPS Study Group et al. Intramuscular interferon beta-1a therapy initiated during a first demyelinating event in multiple sclerosis. N Engl J Med 2000; 343: 898-904
• 11 Comi G, Filippi M, Barkhof F et al. Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study. Lancet 2001; 357: 1576-1582
• 12 Kappos L, Freedman MS, Polman CH et al. Effect of early versus delayed interferon beta-1b treatment on disability after a first clinical event suggestive of multiple sclerosis: a 3-year follow-up analysis of the BENEFIT study. Lancet 2007; 370: 389-397
• 13 Comi G, Martinelli V, Rodegher M et al. Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled trial. Lancet 2009; 374: 1503-1511
• 14 Mix E, Meyer-Rienecker H, Hartung H et al. Animal models of multiple sclerosis – potentials and limitations. Prog Neurobiol 2010; 92; 386-404
• 15 Narayanan S, Francis SJ, Sled JG et al. Axonal injury in the cerebral normal-appearing white matter of patients with multiple sclerosis is related to concurrent demyelination in lesions but not to concurrent demyelination in normal-appearing white matter. Neuroimage 2006; 29: 637-642
• 16 Smith KJ. Sodium channels and multiple sclerosis: roles in symptom production, damage and therapy. Brain Pathol 2007; 17: 230-242
• 17 Coles AJ, Cox A, Le Page E et al. The window of therapeutic opportunity in multiple sclerosis: evidence from monoclonal antibody therapy. J Neurol 2006; 253: 98-108
• 18 Klotz L, Gold R, Hemmer B et al. [Diagnosis of multiple sclerosis 2010 revision of the McDonald criteria]. Nervenarzt 2011; 82: 1302-1309
• 19 Tumani H, Deisenhammer F, Giovannoni G et al. Revised McDonald criteria: The persisting importance of cerebrospinal fluid analysis. Ann Neurol 2011; 70: 520
• 20 Skegg K. Multiple sclerosis presenting as a pure psychiatric disorder. Psychol Med 1993; 23: 909-914
• 21 Staff NP, Lucchinetti CF, Keegan BM. Multiple sclerosis with predominant, severe cognitive impairment. Arch Neurol 2009; 66: 1139-1143
• 22 Irvine H, Davidson C, Hoy K et al. Psychosocial adjustment to multiple sclerosis: exploration of identity redefinition. Disabil Rehabil 2009; 31: 599-606