The term “clinically isolated syndrome” is used to describe a first episode of neurologic symptoms that lasts at least 24 hours and is caused by inflammation and demyelination in one or more sites in the central nervous system.

Individuals who experience a clinically isolated syndrome may or may not go on to develop multiple sclerosis (MS). However, the majority of clinically isolated syndrome cases ultimately progress to MS, a chronic disease that is characterized by further relapses and the accumulation of disability.

Given the importance of early treatment in MS, it is vital to identify factors that predict evolution to MS or risk of disability accumulation over time.

Identifying factors

Researchers from Barcelona carried out a study to identify demographic, clinical, radiological and biological characteristics of individuals with clinically isolated syndrome that might predict development of MS and disability accumulation.

From 1995 to 2013, 1,015 patients with clinically isolated syndrome were included in the study and followed for a mean of 81 months.

Researchers found that the risk factors for developing further attacks and disability accumulation in clinically isolated syndrome patients are categorized as follows:

  • Demographic (e.g. gender) and topographic (area of the central nervous system where inflammation occurs) characteristics are low-impact predictive factors;
  • The presence of oligoclonal bands (i.e. antibodies in the cerebral spinal fluid) is a medium impact predictive factor;
  • The number of lesions on a brain magnetic resonance imaging (MRI) scan is a high-impact predictive factor.

Current evidence suggests that disease-modifying treatment should be started at an early stage because it is likely to significantly impact the disease evolution. In the present study, the authors found that starting disease-modifying treatment before the second attack reduced the risk of conversion to definite MS and disability accumulation.

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