The confavreux lecture: The radiologically isolated syndrome diagnosis, prognosis and perspectives.

Radiologically isolated syndrome (RIS) is the earliest documented stage in the disease continuum of multiple sclerosis (MS). It is discovered incidentally in individuals who are asymptomatic but have typical lesions in the brain or spinal cord suggestive of autoimmune inflammatory demyelination. The revised 2023 RIS criteria aim to secure an accurate and timely diagnosis due to the presence of imaging mimics.

Analysis of healthcare utilization before the diagnosis of radiologically isolated syndrome.

Background: Previous studies have shown that people with multiple sclerosis (MS) had frequent healthcare visits up to 10 years before being diagnosed but with no information from magnetic resonance imaging (MRI) scans of the connection with the radiologically isolated syndrome (RIS).

Objective: To analyze healthcare use 3 years before the RIS diagnosis.

Methods: We examined healthcare usage before the first scan in RIS cases from 2010 to 2019.

Transforming grayscale MRI images to color utilizing generative artificial intelligence to better understand multiple sclerosis.

Multiple sclerosis (MS) falls within the spectrum of central nervous system (CNS) demyelinating diseases that may lead to permanent neurological disability. Fundamental to the diagnosis and clinical surveillance is magnetic resonance imaging (MRI) that allows for the identification of T2-hyperintensities associated with autoimmune injury that demonstrate distinct spatial distribution patterns. Here, we describe the clinical experience of a 31-year-old, right-handed, White man seen in consultation at The University of Texas Southwestern Medical Center in Dallas, Texas, following complaints of headaches that began after head trauma related to military service.

Association between education level and access to disease-modifying treatment in patients with multiple sclerosis in France.

Background: We hypothesized that differences in access to disease-modifying treatments (DMTs) could explain the association between socioeconomic status and disability progression in multiple sclerosis (MS).

Objective: This study aimed to analyze the association between education level and DMT use in France.

Methods: All patients from OFSEP network with MS onset over 1996-2014 and aged ⩾ 25 years at onset were included.

Association between education level and disability progression in patients with multiple sclerosis in France.

Background: Studies have reported an association between socioeconomic status and disability progression in multiple sclerosis (MS), but findings using the pre-MS individual socioeconomic status are missing.

Objective: The objective was to investigate the association between education level and disability progression.

Methods: All Observatoire Français de la Sclérose en Plaques (OFSEP) patients with MS clinical onset over 1960-2014, and aged ⩾25 years at MS onset were included.

French validation of the sexual complaints screener (SCS) for patients with multiple sclerosis.

Background: Sexual dysfunctions are frequent in the general population and even more frequent in individuals with chronic neurological disorders like multiple sclerosis (MS). Several studies indicate that patients would like healthcare workers to address sexual problems. Indeed, such complaints are not currently sufficiently detected and treated.

Alexithymia in radiologically isolated syndrome.

Background: Alexithymia refers to difficulty identifying (DIF) and describing (DDF) feelings and externally oriented thinking (EOT). Its prevalence remains unknown in the radiologically isolated syndrome (RIS), the preclinical multiple sclerosis (MS) phase.

Methods: Alexithymia was measured with the Toronto Alexithymia Scale (TAS-20) in 29 RIS and age and gender-matched healthy controls and relapsing-remitting (RR) MS with an EDSS <3.

Early Disease-Modifying Treatments for Presymptomatic Multiple Sclerosis.

Radiologically isolated syndrome (RIS) is the earliest stage in the disease continuum of multiple sclerosis (MS). RIS is discovered incidentally in individuals who are asymptomatic but have typical lesions in the brain and/or spinal cord suggestive of demyelination. The 2009 and revised 2023 RIS criteria were developed for diagnosis.

Choroid plexus enlargement correlates with periventricular pathology but not with disease activity in radiologically isolated syndrome.

Background: Choroid plexus (ChP) enlargement is an emerging radiological biomarker in multiple sclerosis (MS).

Objectives: This study aims to assess ChP volume in a large cohort of patients with radiologically isolated syndrome (RIS) versus healthy controls (HC) and explore its relationship with other brain volumes, disease activity, and biological markers.

Methods: RIS individuals were included retrospectively and compared with HC.

T2-fluid attenuated inversion recovery fat-suppressed mismatch in the identification and characterization of lesions related to radiologically isolated syndrome.

The radiologically isolated syndrome is defined by the presence of incidentally identified T2-weighted hyperintense lesions, highly suggestive of central nervous system demyelination, following an MRI study that is performed for reasons other than for the investigation of symptoms related to multiple sclerosis (MS). These individuals also have no evidence of prior neurological symptoms associated with inflammatory demyelination and no alternative explanation for the observed MRI findings. Recently, the introduction of novel imaging techniques such as the "central vein sign" has improved lesion specificity for MS.

Dynamic Expansion and Contraction of Multiple Sclerosis T2-Weighted Hyperintense Lesions Are Present Below the Threshold of Visual Perception.

Background And Purpose: The study of T2-weighted hyperintense lesions resulting from autoimmune inflammatory injury and associated volumes within the CNS remains fundamental to the diagnosis and disease surveillance of MS. We investigated the dynamic changes of individual T2-weighted hyperintense MS lesions on MRI and hypothesized that variations may be present below the threshold of visual perception when evaluating longitudinal data.

Materials And Methods: A retrospective study was performed of people with MS, incorporating data from 3 consecutive MRI time points acquired within a single academic center.

Dimethyl fumarate preserves brainstem and cervical spinal cord integrity in radiologically isolated syndrome.

Background And Purpose: The first randomized placebo-controlled therapeutic trial in radiologically isolated syndrome (RIS), ARISE, demonstrated that treatment with dimethyl fumarate (DMF) delayed the onset of a first clinical event related to CNS demyelination and was associated with a significant reduction in new and/or newly enlarging T2-weighted hyperintense lesions. The purpose of this study was to explore the effect of DMF on volumetric measures, including whole brain, thalamic, and subcortical gray matter volumes, brainstem and upper cervical spine three-dimensional (3D) volumes, and brainstem and upper cervical spine surface characteristics.

Methods: Standardized 3T MRIs including 3D isotropic T1-weighted gradient echo images were acquired at baseline and end-of-study according to the ARISE study protocol.

Rituximab alone is as effective as associated with steroids on naive patients with generalized myasthenia gravis.

Introduction: Rituximab (RTX) has been proven effective in managing refractory generalized myasthenia gravis (MG), and its use is increasing worldwide. MG stabilization may initially require oral corticosteroid (CS) therapy, but its long-term side effects require the shortest duration of treatment. We studied the clinical effectiveness and usefulness of corticosteroids associated with RTX compared to RTX alone on MG remission.

Dental Adverse Effects of Anti-CD20 Therapies.

Introduction: Over the past few years, anti-CD20 therapies like rituximab, ocrelizumab or ofatumumab have seen an increase in interest in the treatment of neurological autoimmune disorders such as multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), or resistant forms of generalized myasthenia gravis (MG). They are generally well-tolerated, but recent reports have highlighted severe dental disorders in patients undergoing anti-CD20 therapies. The aim was to describe a series of cases and to compare with the available scientific literature.

Radiologically isolated syndrome in the spectrum of multiple sclerosis.

The radiologically isolated syndrome (RIS) currently represents the earliest detectable preclinical phase of multiple sclerosis (MS). Remarkable advancements have been recently made, including the identification of risk factors for disease evolution, revisions to the existing 2009 RIS criteria, and our understanding of the impact of early disease-modifying therapy use in the prevention/delay of symptomatic MS from two randomized clinical trials. Here, we discuss RIS in the context of the spectrum of MS, implications in the clinical management of individuals, and provide insights into future opportunities and challenges given the anticipated inclusion of asymptomatic MS in the formal definition of MS.

The diagnostic workup of children with the radiologically isolated syndrome differs by age and by sex.

Background: Cerebrospinal fluid (CSF) and spinal MRIs are often obtained in children with the radiologically isolated syndrome (RIS) for diagnosis and prognosis. Factors affecting the frequency and timing of these tests are unknown.

Objective: To determine whether age or sex were associated with (1) having CSF or spinal MRI obtained or (2) the timing of these tests.

Cancer and multiple sclerosis: 2023 recommendations from the French Multiple Sclerosis Society.

Background: Epidemiological data reveal that 45% of persons with multiple sclerosis (PwMS) in France are more than 50 years. This population more than 50 is more susceptible to cancer, and this risk may be increased by frequent use of immunosuppressive drugs. Consequently, concerns have arisen about the potential increased risk of cancer in PwMS and how patients should be screened and managed in terms of cancer risk.

Impact of Immune Checkpoint Inhibitors on the Course of Multiple Sclerosis.

Objectives: Immune checkpoint inhibitors (ICIs) are increasingly used in cancer treatment. Their mechanism of action raises the question of possible exacerbation of preexisting multiple sclerosis (MS). The aim of our study was to assess the risk of increased MS activity, defined by the occurrence of a relapse and/or a new MRI lesion, after ICI initiation.

COVID-19 outcomes in patients with multiple sclerosis: Understanding changes from 2020 to 2022.

Background: Epidemiologic studies on coronavirus disease 2019 (COVID-19) in patients with multiple sclerosis (pwMS) have focused on the first waves of the pandemic until early 2021.

Objectives: We aimed to extend these data from the onset of the pandemic to the global coverage by vaccination in summer 2022.

Methods: This retrospective, multicenter observational study analyzed COVISEP registry data on reported COVID-19 cases in pwMS between January 2020 and July 2022.