Decision-making on radiologically isolated syndrome among Argentinean neurologists: A survey based on clinical experience

Background: 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. Methods: 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. Results: 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%). Conclusion: 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.