‘Subclinical MS’: follow‐up of four cases

@article{Hakiki2008SubclinicalMF,
  title={‘Subclinical MS’: follow‐up of four cases},
  author={Bahia Hakiki and Benedetta Goretti and Emilio Portaccio and Valentina Zipoli and Maria Pia Amato},
  journal={European Journal of Neurology},
  year={2008},
  volume={15}
}
Background and purpose:  Subclinical multiple sclerosis (S‐MS) can be defined as the discovery of characteristic lesions at magnetic resonance (MR) or at autopsy, in the absence of clinical evidence consistent with MS. To describe four cases of S‐MS cases followed‐up with clinical and MR examinations. 
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A clinical case-report of transformation of radiologically isolated syndrome to primary-progressive multiple sclerosis is presented and a review of international and Russian data on the comparison of clinical and MRI characteristics of PPMS is provided.
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Brain MRI findings in patients with asymptomatic lesions in the white matter can be interpreted as demyelinating lesions in some cases, but in the absence of clinical symptoms characteristic of multiple sclerosis, a diagnosis of MS cannot be made in the patients with these incidental findings.
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This article addresses the need for new and updated information on current diagnostic methods for MS, optimal time to initiate treatment of MS, and emerging therapies for MS.
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The incidental detection of multiple sclerosis (MS) typical central nervous system (CNS) lesions fulfilling MRI criteria for dissemination in space (radiologically isolated syndrome, RIS) and its diagnostic, prognostic and therapeutic implications are discussed.
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RIS, according to present criteria, is an uncommon finding in a tertiary hospital setting in a high-prevalence region for MS where awareness and clinical suspicion of MS is common.
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In the published cohorts, during the follow-up period, many patients not only developed an increased number of T2-lesions on MRI, an evidence of temporospatial dissemination – and therefore MS by MRI criteria, but they also exhibited clinical manifestations of central nervous system dysfunction, which is highly suggestive of demyelinating disease.
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The radiologically isolated syndrome has to be classified as a possible preliminary phase of the clinical manifestation of MS in a subgroup of patients and entails in-depth therapeutic considerations.
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