Clinically Isolated Syndrome: Evaluation, Risk Stratification, and Treatment Decisions*

Recently a group of community and academic neurologists gathered to discuss current topics of interest in multiple sclerosis (MS). The goal of the meeting was to provide an up-to-date review of the literature and to gather consensus opinions regarding key aspects of each of these topics. This article is the product of one of these sessions that focused on the initial clinical event suggestive of demyelinating disease: the so-called clinically isolated syndrome (CIS). One of the key questions addressed in this monograph is how to stratify risk in the patient with CIS. How useful are brain magnetic resonance imaging (MRI), cerebrospinal fluid analysis, evoked potential tests, and serological assays in determining which patients with CIS will go on to have subsequent attacks and who is at highest risk for neurologic disability? Do recent advances in our understanding of cognitive changes and ultrastructural changes revealed by non-conventional MRI in patients with CIS indicate that more widespread injury to the central nervous system has already occurred at the time of the initial presenting event? Lastly, how useful are disease-modifying therapies in preventing further attacks, reducing the accumulation of new lesions apparent on brain MRI, and, most importantly of all, preventing neurologic disability? Does our understanding of MS pathophysiology help support early treatment in MS and CIS? (Adv Stud Med. 2008;8(8):257-265)