b'Medicine & ResearchClinically Isolated SyndromesThe challenge is determining how best to assess the MS riskBy Dr. Ben ThrowerMost individuals with MS will begin their A CIS is treated in the same way as an MSjourney with relapsing-remitting MS. In fact, relapse, with options ranging from observation,85percentofindividualslivingwithMS to steroids, IVIG, or plasma exchange. Thepresent with this diagnosis. The starting point decision to treat or observe usually dependsfor RRMS is clinically isolated syndrome. CIS on the severity and functional limitations ofis the very rst clinical attack or relapse of the symptoms, and any comorbidities. OnceRRMS, but not every person who experiences a an immediate treatment plan is in place, theCIS will go on to develop MS. CIS may manifest nextquestionis whetherthispersonisatas transverse myelitis, optic neuritis, or a high risk for the development of MS. Thisbrainstemsyndrome.Whilethesearethe risk is determined by the MRI ndings, CSFmost common forms of CIS, there are countless exam, and clinical presentation. other variationsofCISdependingupon The diagnosis of RRMS has been denedwhere in the central nervous system the as the dissemination of focal neurologicallesion is. Lets take a closer look at a few types eventsintimeandspace.Classically,thisof CIS and how we might predict who is at meant that a person had to have two relapsesrisk for developing MS after a CIS. or attacks before a diagnosis of MS could beTransverse myelitis is inflammatory established. The danger in waiting for ademyelination in the spinal cord. This could second clinical attack before making an MSresult in changes in sensation, weakness, diagnosis lies in the presence of subclinical,in coordination, or changes in bladder and or hidden, disease activity that occurs inbowel function. Depending on whether the between attacks. Some studies have suggestedinammation is in the cervical spinal cord or that for every clinical MS relapse we are awarethoracic spinal cord, transverse myelitis may of, there can be ve to 10 new silent lesionsinvolve only the legs or both the arms and legs. on MRI. Therefore, the challenge in evaluatingOptic neuritis is inammatory demyelination the person with CIS is in determining howin the optic nerve. Optic neuritis typically best to assess the risk quickly and accuratelyresults in blurred vision in the aected eye, loss for MS.of color (especially sensitivity to the color red), MS is currently diagnosed using theand pain with eye movement. Demyelination McDonald Criteria. Through these guidelines,within the brainstem can cause double vision, we can use the clinical presentation, MRI,facial weakness,trigeminalneuralgia, and CSF ndings to make an MS diagnosis.weakness, or incoordination. In recent years, the McDonald Criteria haveTreatment and Prognosisevolved to allow MRI lesions to count as clinicalWhen a person presents with a CIS, there relapses. This has sped up the diagnosis ofreally are two issues: treatment and prognosis. MS for many cases. It is possible to make themsfocusmagazine.org 36'