Clinically isolated syndromes suggestive of multiple sclerosis
- Michael J Olek, DO
Michael J Olek, DO
- Associate Professor of Neurology
- Loma Linda University Medical Center
INTRODUCTION AND DEFINITION
A clinically isolated syndrome (CIS) is a single attack compatible with multiple sclerosis, such as optic neuritis. An episode of CIS can create diagnostic and therapeutic dilemmas, since a substantial percentage of patients with CIS and MRI lesions go on to develop multiple sclerosis. Identifying those likely to develop multiple sclerosis may have particular importance, since accumulating evidence suggests that starting disease modifying therapies for patients with CIS can delay conversion to clinically definite multiple sclerosis.
A radiologically isolated syndrome (RIS) suggestive of multiple sclerosis is defined as a presentation without overt clinical symptoms but with MRI findings highly suggestive of multiple sclerosis based upon location and morphology within the central nervous system .
This topic will discuss the evaluation and treatment of CIS and RIS suggestive of multiple sclerosis.
Optic neuritis and other aspects of multiple sclerosis are discussed separately. (See "Diagnosis of multiple sclerosis in adults" and "Clinical features of multiple sclerosis in adults" and "Disease-modifying treatment of relapsing-remitting multiple sclerosis in adults" and "Treatment of progressive multiple sclerosis in adults" and "Symptom management of multiple sclerosis in adults" and "Optic neuritis: Pathophysiology, clinical features, and diagnosis" and "Optic neuritis: Prognosis and treatment".)
The typical patient with a clinically isolated syndrome (CIS) presents as a young adult with a single episode of central nervous system dysfunction followed by at least partial resolution. In contrast, a radiologically isolated syndrome (RIS) is defined by incidental MRI findings highly suggestive of multiple sclerosis in an asymptomatic patient lacking any history, symptoms, or signs of multiple sclerosis.
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- INTRODUCTION AND DEFINITION
- CLINICAL PRESENTATION
- Clinically isolated syndromes
- Radiologically isolated syndrome
- PROGRESSION TO MULTIPLE SCLEROSIS
- With a radiologically isolated syndrome
- After isolated optic neuritis
- After acute transverse myelitis
- McDonald diagnostic criteria
- - Applying the MRI criteria
- Oligoclonal bands
- Antimyelin antibodies
- - Clinical trials
- Glatiramer acetate
- Intravenous immune globulin
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS