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Clinically isolated syndromes

Predicting and delaying multiple sclerosis

From the Multiple Sclerosis Center at Shepherd, Dunwoody, Georgia.

Address correspondence and reprint requests to Dr. Ben. W. Thrower, Medical Director, Multiple Sclerosis Center at Shepherd, 1525 Edison Hall Drive, Dunwoody, GA 30338 Ben_Thrower{at}shepherd.org

Multiple sclerosis (MS) represents a spectrum of demyelination that depends on disease duration and clinical categorization. Most patients present with the relapsing–remitting form of the disease. The earliest clinical presentation of relapsing–remitting MS (RRMS) is the clinically isolated syndrome (CIS). Predicting which CIS patients are at high risk for MS is complicated by the disparity between clinical attacks and the extent of axon pathology. However, recent interferon-beta (IFN-ß) trials have demonstrated a delay in time to the second demyelinating event with early treatment, and early treatment could also slow the progression from RRMS to secondary-progressive MS (SPMS). Clinical findings in combination with brain MRI and CSF analysis can be used in CIS patients to evaluate their risk for clinically definite MS (CDMS). Application of the McDonald criteria also allows an earlier MS diagnosis by using new MRI lesions to define dissemination in time. Early immunomodulatory therapy for selected CIS patients may eventually prevent future axon pathology and progression of disability in this lifelong disease.

Disclosure: Dr. Thrower receives research funding from Abbott Laboratories, Acorda Therapeutics, Inc., Berlex, Inc., Genentech, Inc., Serono, Inc., and Teva Neuroscience, Inc. IFN-ß1a (Rebif®) is not approved for the treatment of clinically isolated syndromes. Publication of this supplement was supported by an educational grant from Bayer HealthCare Pharmaceuticals Inc.

Neurology® supplements are not peer-reviewed. Information contained in Neurology® supplements represents the opinions of the authors and is not endorsed by nor does it reflect the views of the American Academy of Neurology, Editorial Board, Editor-in-Chief, or Associate Editors of Neurology®.

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