References for this review were identified from searches of the extensive files of the authors; presentations at the MAGNIMS Workshop, held in London in January 2004 (see acknowledgments); access to PubMed citations between 1985 and December 2004; and references from relevant articles. A few abstracts and reports from the MAGNIMS meeting were also included. The final reference list was generated from papers that were original and relevant to the topics covered in the review.
ReviewClinically isolated syndromes suggestive of multiple sclerosis, part I: natural history, pathogenesis, diagnosis, and prognosis
Section snippets
Clinical presentation
Review of a large database of patients with CISs found that 21% presented with optic neuritis, 46% with longtract symptoms and signs, 10% with a brainstem syndrome, and 23% with multifocal abnormalities.1 Therefore, the syndrome was isolated in space in only 77% of presentations, although all presentations were isolated in time. The presentation of MS affects disease course and prognosis (panel 1).2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15
Studies of the clinical features and natural history
Pathology
There are few, if any, studies on the pathological changes that occur in CISs, and most that there are focus on more aggressive forms of inflammatory demyelination such as Balo's concentric sclerosis, Marburg's disease, Schilder's disease, and acute disseminated encephalomyelitis. Initial presentation with a large mass lesion (so-called tumefactive MS) may also pose diagnostic difficulties. However, the finding of many infiltrating macrophages in the setting of myelin loss with relative
Diagnosis
Clinical suspicion of demyelination is high when a young person has an episode consistent with damage to white-matter tracts; however, many diseases cause similar episodes. A comprehensive review of the differential diagnosis of MS is beyond the scope of this review; however a few caveats should be mentioned. First, the diagnosis in patients with CIS—MS, another neurological disorder, or CIS only—is a clinical decision and should be made by a neurologist experienced in the relevant differential
MRI assessment of long-term prognosis
Although many studies assess the predictive value of MRI in the short term, few have addressed the mid-term to long-term, partly because this technique was introduced in the mid 1980s. Research into the predictive value of MRI in the mid-term to long-term is crucial. Too short a follow-up will lead to ascertainment bias and might lead to overestimation of the role of MRI by identifying only those patients in whom the period for conversion is short. There is also little change in disability in
Search strategy and selection criteria
References (69)
- et al.
Effect of early interferon treatment on conversion to definite multiple sclerosis
Lancet
(2001) - et al.
Studies on the natural history of multiple sclerosis–8. Early prognostic features of the later course of the illness
J Chronic Dis
(1977) - et al.
Intrathecal IgG synthesis and autoantibody secreting cells in multiple sclerosis
J Neuroimmunol
(2000) - et al.
CD4 T cell activation and disease activity at onset of multiple sclerosis
J Neuroimmunol
(2004) - et al.
Management of acute optic neuritis
Lancet
(2002) - et al.
Relapses and progression of disability in multiple sclerosis
N Engl J Med
(2000) - et al.
Early clinical predictors and progression of irreversible disability in multiple sclerosis: an amnesic process
Brain
(2003) - Nilsson P, Larsson E-M, Maly-Sundgren P, Perfekt R, Sandberg-Wollheim M. Predicting the outcome of optic...
- et al.
Long-term follow-up of patients with clinically isolated syndromes, relapsing remitting and secondary progressive multiple sclerosis
Mult Scler
(2003) - et al.
The natural history of multiple sclerosis: a geographically based study—2. Predictive value of the early clinical course
Brain
(1989)
The natural history of multiple sclerosis: a regional study with some longitudinal data
J Neurol Neurosurg Psychiatry
Correlation of clinical, magnetic resonance imaging and cerebrospinal fluid findings in optic neuritis
Ann Neurol
A longitudinal study of abnormalities on MRI and disability from multiple sclerosis
N Engl J Med
High- and low-risk profiles for the development of multiple sclerosis within 10 years after optic neuritis
Arch Ophthalmol
Infratentorial lesions predict long term disability in patients with initial findings suggestive of multiple sclerosis
Arch Neurol
MRI, VEP, SEP and biothesiometry suggest monosymptomatic acute optic neuritis to be a first manifestation of multiple sclerosis
Acta Neurol Scand
The significance of brain magnetic resonance imaging abnormalities at presentation with clinically isolated syndromes suggestive of multiple sclerosis
Brain
Optic neuritis: findings on MRI, CSF examination and HLA class II typing in 60 patients and results of a short-term follow-up
Neurology
The effect of corticosteroids for acute optic neuritis on the subsequent development of multiple sclerosis
N Engl J Med
Intramuscular interferon beta-1a therapy initiated during the first demyelinating event in multiple sclerosis
N Engl J Med
Is optic neuritis more benign than other first attacks in multiple sclerosis?
Ann Neurol
The prognostic value of brain MRI in clinically isolated syndromes of the central nervous system: a 10 year follow-up
Brain
Cognitive impairment in patients with clinically isolated lesions of the type seen in multiple sclerosis: a psychometric and MRI study
Brain
Clinically isolated lesions of the type seen in multiple sclerosis: a cognitive, psychiatric, and MRI follow up study
J Neurol Neurosurg Psychiatry
Changes in the normal appearing brain tissue and cognitive impairment in multiple sclerosis
J Neurol Neurosurg Psychiatry
A longitudinal study of brain atrophy and cognitive disturbances in the early phase of relapsing-remitting multiple sclerosis
J Neurol Neurosurg Psychiatry
Spectroscopic axonal damage of the right locus coeruleus relates to selective attention impairment in early stage relapsing-remitting multiple sclerosis
Brain
MR study of the influence of tissue damage and cortical reorganization on PASAT performance at the earliest stage of multiple sclerosis
Neurology
Heterogeneity of multiple sclerosis lesions: Implications for the pathogenesis of demyelination
Ann Neurol
Relapsing-remitting multiple sclerosis: pathology of the newly forming lesion
Ann Neurol
Pathogenesis of multiple sclerosis: the eyes only see what the mind is prepared to comprehend
Ann Neurol
The neuropathology of multiple sclerosis
Cortical lesions in multiple sclerosis
Brain
Transected neuritis, apoptotic neurons, and reduced inflammation in cortical multiple sclerosis lesions
Ann Neurol
Cited by (469)
Multiple Sclerosis: An Emergency Medicine-Focused Narrative Review
2024, Journal of Emergency MedicineThe novel small molecule TPN10518 alleviates EAE pathogenesis by inhibiting AP1 to depress Th1/Th17 cell differentiation
2023, International ImmunopharmacologyBiochemical biomarkers for multiple sclerosis
2023, Clinica Chimica ActaMultiple sclerosis: role of meningeal lymphoid aggregates in progression independent of relapse activity
2023, Trends in ImmunologyPredictive factors of multiple sclerosis relapse after the first demyelinating event: A 5-year follow-up
2023, Multiple Sclerosis and Related Disorders