CIS

   

Example presentations

 

Image on an eye representing unilateral optic neuritis.

Unilateral optic neuritis1,2

  • Gradual onset monocular visual loss
  • Pain on moving the eye
  • Altered colour vision

Image of spinal cord representing partial myelitis.

Partial myelitis1,2

  • Gradual onset sensory and motor symptoms of the limbs
  • Cervical: Lhermitte’s phenomenon
  • Thoracic: tight band-like sensation around the chest or abdomen

Image of brain representing brain stem syndrome.

Brainstem syndromes1,2

  • Diplopia
  • Oscillopsia
  • Facial sensory loss
  • Vertigo
  • Dysarthria
 

Diagnosis of MS from CIS

  • Historically, MS could only be diagnosed from a second attack because it is characterised by CNS lesions that are disseminated in both space and time1
  • The 2017 revisions of the McDonald diagnostic criteria allow the diagnosis of MS from a typical CIS if the following are met:1
    • Clinical or MRI criteria for dissemination in space
    • No better explanation for the clinical presentation
    • Demonstration of CSF oligoclonal bands in the absence of atypical CSF findings

 

Orange speech bubble with text 'CIS is less relevant than it once was, and about half of people previously considered to have the condition are now considered to have MS'- NICE.

 

Management

  • Many CIS episodes are mild and resolve without therapeutic intervention1
  • Corticosteroids can be used when the symptoms are functionally disabling, or patients do not spontaneously improve4
  • There is a paucity of data on the efficacy of DMT treatment for CIS, as defined in the 2017 diagnostic criteria3
    • This led the National Institute for Health and Care Excellence (NICE) to conclude that there is insufficient evidence to make any recommendations for DMT use in CIS
Image of a person with two circles around the body representing CIS management.
 

CIS, clinically isolated syndrome; CNS, central nervous system; CSF, cerebrospinal fluid; DMT, disease-modifying therapy; MRI, magnetic resonance imaging; MS, multiple sclerosis.

References

  1. Thompson AJ, Banwell BL, Barkhof F, et al. Lancet Neurol. 2018;17:162–173.
  2. Ford H. Clin Med. 2020;20(4):380–383.
  3. NICE. Beta interferons and glatiramer acetate for treating multiple sclerosis: TA257 [online] June 2018. Available from: https://www.nice.org.uk/guidance/ta527/resources/beta-interferons-and-gl... [Last accessed: March 2021].
  4. Efendi H. Noro Psikiyatr Ars. 2015;52(Suppl 1):S1–S11.
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UK | April 2021 | 120966
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