Clinical Research Of Clinically Isolated Syndromes

Clinically isolated syndrome (CIS) is the initial demyelinating event in the central nervous system, and often present as unilateral optic neuritis, isolated brainstem or partial spinal-cord syndromes. In 85% patients with multiple sclerosis (MS), onset is a CIS, and 30–70% of patients with a CIS develop MS. CIS is generally defined as one episode with one lesion. Recent views prefer CIS as an monophasic syndrome, which could be monofocal or multifocal in MRI lesions. Visual evoked potentials are sensitive to optic neuritis, but not other evoked potentials to brain lesions. Oligoclonal band in cerebrospinal fluid is an independent prognostic factor for relapses. Multifocal, efferent systems affected, abnormal and so on in CIS are more likely to lead to poor prognosis. The McDonald criteria which define dissemination in time and space with MRI parameters , have significantly improved the early diagnosis of MS, and are a more sensitive prognostic criterion for CIS. Great progresses have been made recently in clinical trials. Disease-Modifying Treatment is regarded as the most promising treatments with several immunomodulatory drugs, such as Interferon beta and glatiramer acetate. To make an early diagnosis, evaluate the risk of conversion to MS and give the disease-modifying therapies, will contribute to prevent disease progression and reduce the mutilation rate. To date, there is a dearth of clinical studies on CIS in early MS in China.We identified patients with CIS at early MS admitted to our hospital from Feb. 2002 to Feb. 2007. The follow-up time ranged from 12 to 168 months (mean follow-up 12months). Retrospectively studies are on the clinical symptoms, evoked potentials, cerebrospinal fluid tests, MRI, drug treatment and the EDSS scores. We also studied the clinical and MRI features in spinal CISs.Reviewed the published articles on CIS in recent years, we summarized the clinical features, diagnosis, treatment and prognosis of CIS at early MS. 82.3% of MS patients in the early performance were the CIS. 89.9% of CIS has acute or subacute onset; 51.9% is spinal cord syndrome, 21.5% is optic neuritis, and 13.9% is isolated brainstem syndrome. 35.3% presented with "multifocal" plagues in MRI. In spinal CIS, 81.7% of the MRI lesions were not more than two vertebral segments, and 89.0% in the axial diameter of the spinal cord did not exceed 1/2. The number, volume and area of MRI lesions at baseline confirmed the positive correlation with EDSS at diagnosis of MS. Corticosteroid therapy before and after the EDSS score was of a significant difference.Clinical features of CIS are of variety. Patients with an initial demyelinating symptom of the white matter should be carefully diagnosed with evidences in MRI, CSF-IgG, oligoclonal bands and evoked potentials tests. MRI is of high positive rate in CIS as the most sensitive, specific and exact test for diagnosis. MRI measures are especially valuable indicators of a higher risk of CDMS and also a more pronounced treatment effect. New McDonald criteria provide a more practical and exact predictor of conversion risks. Intravenous corticosteroids are contributed to the rapid recovery of early acute symptoms, but have no use in the prevention of progression. Many disease-modifying drugs, such as interferon beta, glatiramer acetate and natalizumab have been proved effective at reducing the probability of converting to clinical definite MS. Clinical trials indicate benefits from early disease-modifying treatment.