Clinically Isolated Syndrome (CIS)

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CHAPTER 1 – GENERAL PRINCIPLES

1.1 Terminology
Clinically isolated syndrome (CIS) is a central nervous system demyelinating event isolated in time that is may or may not lead to the development of multiple sclerosis (MS). It is a term that describes a first clinical episode with features suggestive of multiple sclerosis (MS). It usually occurs in young adults (19-30 years old) and affects optic nerves, the brainstem, or the spinal cord. Although patients usually recover from their presenting episode. (1)
The term “clinically isolated syndrome” (CIS) is used to describe a first episode of neurologic episode that lasts at least 24 hours and is caused by inflammation and demyelination in one or more sites in the central nervous system (CNS). …show more content…
In diagnosing CIS, the physician faces two challenges: first, to determine whether the patient is experiencing a neurologic episode caused by damage of the CNS, and second, to determine the possibility that a person experiencing this type of demyelinating episode is having high risk to develop MS. Of the people who are eventually diagnosed with MS, 85% experienced a first attack that is referred to as a clinically isolated syndrome (CIS). (1) If an MRI scan of the brain and spinal cord shows evidence suggestive of MS at the time of a clinically isolated syndrome or at the time of a second episode, then MS will be diagnosed. However, not all patients who experience a clinically isolated syndrome will go to develop MS (2). For many patients, there will be no MRI evidence suggestive of MS and no further symptoms or …show more content…
Long term follow up studies of patients presenting with an isolated clinical syndrome characteristic of multiple sclerosis led to the identification of risk factors for conversion to clinically definite multiple sclerosis (3).
Today, no uniform consensus definition for a clinically isolated syndrome exists. In 2008, a panel of multiple sclerosis experts recommended that a clinically isolated syndrome be defined as a monophasic presentation with suspected underlying inflammatory demyelinating disease and recommended 5 subtypes based on monofocal or multifocal symptoms, presence or absence of asymptomatic MRI lesions, or patients without symptoms but with a suggestive MRI (3,4).
1.3 Epidemiology
A study was made to determine whether the incidence of clinically isolated syndrome (CIS) the precursor form of multiple sclerosis (MS) that encompasses optic neuritis and transverse myelitis as well as other clinical presentations, varies by race/ethnicity in a multi-ethnic, population-based cohort
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