From the Guidelines
Approximately 60-80% of early multiple sclerosis (MS) cases begin as isolated neurologic events, also known as clinically isolated syndrome (CIS). These events typically manifest as optic neuritis, transverse myelitis, or brainstem syndromes that last at least 24 hours and occur in the absence of fever, infection, or other precipitating factors. The conversion rate to clinically definite MS is approximately 60-80% within 5-10 years for patients who have MRI lesions at the time of their initial presentation 1.
Key Points
- Isolated neurologic events, such as CIS, are a common initial presentation of MS
- The presence of MRI lesions at the time of CIS significantly increases the risk of progression to definite MS
- Prompt neurological evaluation and MRI imaging are crucial for early diagnosis and treatment initiation
- The conversion rate to clinically definite MS is approximately 60-80% within 5-10 years for patients with MRI lesions at the time of their initial presentation
Importance of Early Diagnosis
Early diagnosis and treatment of MS can significantly improve patient outcomes, reducing the risk of disability progression and improving quality of life. Therefore, it is essential to prioritize prompt neurological evaluation and MRI imaging for patients with new neurological symptoms. The high percentage of early MS presenting as isolated events underscores the importance of careful consideration of MS in the differential diagnosis of patients with CIS.
From the Research
Isolated Neurologic Events in Early MS
- Around 85% of cases of multiple sclerosis (MS) start with an acute neurological episode, a clinically isolated syndrome, which is considered to be the first clinical episode of relapsing-remitting MS (RRMS) 2, 3.
- This initial episode is often characterized by the presence of acute relapses, after which there is normally good functional recovery 2.
- Clinically isolated syndrome can present with various clinical syndromes, including optic neuritis, myelitis, brainstem/cerebellum syndrome, and supratentorial syndrome 2, 4, 5.
- The fact that 85% of MS cases begin with a clinically isolated syndrome suggests that isolated neurologic events are a common initial presentation of the disease 2, 3.