Multiple sclerosis: early indicators of disease and assessing future risk
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JOURNAL CLUB
Multiple sclerosis: early indicators of disease and assessing future risk M. D. Willis1,2 · N. P. Robertson1,2
© The Author(s) 2020
Over the last decade, the number of disease-modifying treatments (DMTs) available to patients with multiple sclerosis (MS) has exponentially increased in number. For clinicians equipped with this armamentarium, who and when to treat to maximise therapeutic efficacy, whilst being ever mindful of potential serious side effects has become a focus of routine clinical practice. With the severity of the MS clinical phenotype ranging so widely from benign to aggressive disease, the ability of a clinician to be able to make an accurate forecast of a patient’s disease trajectory is of great value. Stratifying patients based on available clinical and radiological data allows an informed decision to be made about the intensity of disease surveillance and the balance of risk and benefits of different therapeutic agents. However, this is an imprecise science and further studies aiding understanding of this are to be welcomed. Once a diagnosis is made, early treatment with immunosuppressive or immunomodulating therapies is increasingly favoured to prevent future episodes of neuroinflammation and disability accumulation in the longer term. As such, any novel methods to detect and diagnose disease at an earlier stage are an area of keen interest to neurologists working in this field. In this months’ journal club, we consider three papers whose aim is to aid earlier diagnosis and predict disease development and trajectory. First, Outteryck and colleagues investigate the use of optical coherence tomography in aiding the detection of both symptomatic and asymptomatic optic nerve lesions in patients with clinically isolated syndrome. This technique may have clinical utility where optimal radiological imaging is unavailable for the detection of optic nerve lesions and potentially in the development of * N. P. Robertson [email protected] 1
Department of Neurology, University Hospital Wales, Cardiff CF14 4XN, UK
Institute of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK
2
future MS diagnostic criteria. In the second paper, LebrunFrenay et al. evaluate the 10-year risk of a clinical event following a diagnosis of radiologically isolated syndrome (RIS). This large cohort study is informative for both clinicians and patients alike in understanding future development of disease. In the third paper, the MSBase study group identify early clinical markers of aggressive MS development and reveal easily accessible parameters to help identify such patients. These studies will help clinicians in evaluating the risk of MS disease development and subsequent disease progression. In turn, this will inform predictions of disease trajectory, aid patient counselling and inform individual management decisions.
Optical coherence tomography for detection of asymptomatic optic nerve lesions in clinically isola
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