Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina.
Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina.
Mult Scler Relat Disord. 2019 Jan;27:61-64. doi: 10.1016/j.msard.2018.09.030. Epub 2018 Oct 2.
Although management of radiologically isolated syndrome (RIS) is still a challenge in clinical practice, in the absence of evidence-based guidelines, the report of survey results might give neurologists some guidance to optimize clinical decision-making. Our aim was to investigate the current RIS management approach of Argentinean neurologists based on their clinical experience.
An anonymous voluntary cross-sectional web-based survey was performed by Argentinean neurologists. We developed questions based on a hypothetical patient with RIS. General agreement was defined as at least 75% of concordance in the answer to each particular question.
Sixty-six out of 91 (72%) neurologists completed the survey. There was general agreement on following up patients, performing further examinations and not treating RIS patients at presentation. In addition, participants agreed to perform a lumbar puncture to evaluate the presence of oligoclonal bands (OCB, 82%) and to order a spinal cord MRI (75.4%). During follow-up, there was agreement to perform brain (100%) and spinal (80%) MRI. A few participants would prescribe treatment to RIS patients with both Gd-negative and Gd-positive lesions on spinal MRI. In addition, if a brain Gd-positive lesion is observed at onset, 43.6% would prescribe treatment. During the follow-up, only 15.4% would initiate treatment in the absence of clinical symptoms, regardless of the examinations' results. In those cases in which a treatment was prescribed, there was agreement in using injectable drugs (78.7%).
These findings give us a first idea about Argentinean neurologists' decision-making on this entity and may help in the development of a practice guideline.
尽管放射学孤立综合征（RIS）的管理在临床实践中仍然是一个挑战，但在缺乏循证指南的情况下，报告调查结果可能会为神经科医生提供一些指导，以优化临床决策。我们的目的是根据阿根廷神经科医生的临床经验，调查他们目前对 RIS 的管理方法。
阿根廷神经科医生进行了一项匿名自愿的横断面网络调查。我们根据假设的 RIS 患者制定了问题。一般共识定义为对每个特定问题的回答至少有 75%的一致性。
91 名神经科医生中有 66 名（72%）完成了调查。在随访患者、进行进一步检查以及不在初次就诊时治疗 RIS 患者方面存在普遍共识。此外，参与者同意进行腰椎穿刺以评估寡克隆带（OCB，82%）的存在，并进行脊髓 MRI（75.4%）检查。在随访期间，有 100%的参与者会进行脑部 MRI 和 80%的参与者会进行脊髓 MRI 检查。少数参与者会对脊髓 MRI 上既有 Gd 阴性又有 Gd 阳性病变的 RIS 患者进行治疗。此外，如果在发病时观察到脑部 Gd 阳性病变，43.6%的参与者会进行治疗。在随访期间，无论检查结果如何，只有 15.4%的参与者会在没有临床症状的情况下开始治疗。在那些需要治疗的情况下，有 78.7%的参与者会使用注射药物。
这些发现让我们对阿根廷神经科医生在这一实体上的决策有了初步的了解，并可能有助于制定实践指南。
