Updates on Clinically Isolated Syndrome and Diagnostic Criteria for Multiple Sclerosis

Abstract

Clinically isolated syndrome (CIS) is a central nervous system demyelinating event isolated in time that is compatible with the possible future development of multiple sclerosis (MS). Early risk stratification for conversion to MS helps with treatment decisions. Magnetic resonance imaging (MRI) is currently the most useful tool to evaluate risk. Cerebrospinal fluid studies and evoked potentials may also be used to assess the likelihood of MS. Four clinical trials evaluating the benefits of either interferon b (IFN-b) or glatiramer acetate (GA) within the first 3 months after a high-risk CIS demonstrate decreased rates of conversion to clinically definite MS (CDMS) and a lesser degree of MRI progression with early treatment. In the 3-, 5-, and 10-year extension studies of 2 formulations of IFN-b, the decreased conversion rate to CDMS remained meaningful when comparing early treatment of CIS to treatment delayed by a median of 2 to 3 years. Diagnostic criteria have been developed based on the clinical and MRI follow-up of large cohorts with CIS and provide guidance on how to utilize clinical activity in combination with radiographic information to diagnose MS. The most recent 2010 McDonald criteria simplify requirements for dissemination in time and space and allow for diagnosis of MS from a baseline brain MRI if there are both silent gadolinium-enhancing lesions and nonenhancing lesions on the same imaging study. The diagnostic criteria for MS require special consideration in children at risk for acute disseminated encephalomyelitis (ADEM), in older adults who may have small vessel ischemic disease, and in ethnic groups that more commonly develop neuromyelitis optica (NMO).

Impact of early diagnosis on clinical characteristics of an Italian sample of people with multiple sclerosis recruited online

“…These criteria simplify requirements for dissemination in space and time and lead to an earlier diagnosis of MS from a single baseline brain MRI (Traboulsee et al, 2016). This is particularly relevant because patients with a single clinical episode due to inflammatory demyelination, commonly referred to as a Clinically Isolated Syndrome (CIS), in the presence of multiple brain lesions, are at high risk of developing clinically definite MS (Marcus and Waubant, 2013). Despite McDonald criteria are essential for research and pharmacological clinical trials but optional in routine clinical practice, nowadays neurologists with MS experience are familiar with these criteria thus accuracy is ensured in the differential diagnosis between "MS" and "not MS" (Gafson et al, 2012).…”

Алгоритм Використання Комплексу Лабораторних Біомаркерів У Хворих На Розсіяний Склероз Із Діагностичною Та Прогностичною Метою

“…У більшості пацієнтів, яким установлювався діагноз КІС, протягом наступних десяти років підтверджують діагноз КВРС [7]. Однак не завжди КІС перетворюється в РС, а час такої трансформації залишається невизначеним.…”

Differential diagnosis of primary progressive multiple sclerosis

“…Тем не менее, олигоклональные IgG иногда определяются у больных с другими неврологическим воспалительными заболеваниями, а их наличие необходимо интерпретировать с осторожностью. Олиго кло нальные IgG в цереброспинальной жидкости наблюдаются при многих заболеваниях, в том числе синдроме Шегрена (75-90% пациентов с неврологической симптоматикой), нейросаркоидозе (40-70%), системной красной волчанке (30-50%), болезни Бехчета (20-50%), паранеопластических расстройствах (5-25%), синдроме Фогта-Коянаги-Харада (30-60%), стероид-чувствительной энцефалопатии Хасимото (25-35%), подостром склерозирующем панэнцефалите (100%), краснухе, клещевом энцефалите (100%), нейросифилисе (90-95%), нейроборрелиозе (80-90%), ВИЧинфекции (60-80%), адренолейкодистрофии (100%), синдроме телеангиэктазии-атаксии (50-60%), наследственной болезни Лебера (5-15%), сосудистых поражениях ЦНС (5-25%), а также объемных и структурных поражениях ЦНС (<5%) [22].…”