Radiologically isolated syndrome (RIS) and MS

Lots of people are diagnosed with RIS and never get MS. But for some it’s an early sign that they’ll go on to develop MS.

But what if a scan shows damage that’s typical of MS and you also get a one-off occasion of symptoms like MS? Then you’ll be diagnosed with clinically isolated syndrome (CIS) instead.

What does radiologically isolated syndrome mean?

• ‘Radiologically’ means doctors can see signs that something is wrong on an MRI scan.
• ‘Isolated’ means what has happened is, so far, a one-off event.
• A ‘syndrome’ is a collection of signs or symptoms that something’s not right in your body.

When is RIS diagnosed?

RIS is usually spotted when someone has a scan of their brain or spinal cord for something unrelated to MS. This could be something like an injury or headaches.

How is RIS diagnosed?

Only a neurologist (a nerve specialist) can diagnose RIS. On your scan they see signs of damage to your brain or spinal cord called a lesion. This is an area of inflammation and damage to the myelin around the nerves. Myelin is the fatty covering around nerves that protects them and helps signals pass along them.

These lesions look very much like what neurologists see on scans of people with MS. The difference is that with RIS you don’t get any obvious MS-like symptoms. That said, there might be subtle signs that something is wrong. When doctors look closely, they see that about 1 in 3 people with RIS show signs that their memory, thinking or concentration are affected in a mild way. Sometimes anxiety and depression might be a sign of RIS, too.

Will RIS lead to a diagnosis of MS?

A lot of people with RIS never go on to be diagnosed with MS. But in one study around half of those with RIS were diagnosed with some type of MS within ten years. There’s no agreed treatment yet to stop RIS leading to MS, or to delay this.

Some things make it more likely that RIS will lead to someone’s first MS-like symptoms (called a clinically isolated syndrome or CIS):

• being younger when you’re diagnosed with RIS
• having lesions on your spinal cord
• if fluid around your spinal cord is tested and the test finds oligoclonal bands.

An oligoclonal band is a type of protein (called immunoglobulin). If a test (called a lumbar puncture) of the fluid around your spine finds these bands, it’s a sign that your immune system has been active in your brain or spinal cord. This only happens with MS. If you have RIS which then leads to CIS, chances are very high that you’ll then be diagnosed with MS within a couple of years.