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Clinically isolated syndrome: the rationale for early treatment

Nature Clinical Practice Neurology volume 4, pages 234–235 (2008)Cite this article

The findings of numerous studies on early events in multiple sclerosis (MS) demonstrate that the first symptoms that hint at the presence of MS should be taken very seriously and that early treatment initiation is in the patient's best interest.

Most patients who develop MS initially present with a single neurological event suggestive of MS, known as a clinically isolated syndrome (CIS). Typically, such events affect the optic nerve, brain stem or spinal cord. Although a CIS alone is not sufficient for a diagnosis of MS, most patients with CIS proceed to have a second attack, which confirms the onset of MS. This second event tends to be followed by a pattern of acute attacks of neurological dysfunction that are separated in time by periods of full or partial remission, a disease form known as relapsing–remitting MS (RRMS). Following each attack, the patient might regain neurological function, or be left with residual disability. Recent clinical trials have shown that disease-modifying therapies for MS, such as interferon beta (IFN-β), are more effective the earlier treatment is initiated.1 Historically, such immunomodulatory drugs were used after the establishment of a definite diagnosis of MS, but more-recent evidence highlights the value of treatment initiation immediately after a CIS,2 leading to a paradigm shift towards early treatment.

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  1. Institute of Experimental Neurology, Department of Neurology, Scientific Institute San Raffaele, Via Olgettina 48, 20132 Milan, Italy g.comi@hsr.it

Authors and Affiliations

  1. G Comi is a Professor of Neurology and Chairman of the Department of Neurology, Vita-Salute San Raffaele University, Milan, Italy.,

    Giancarlo Comi

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  1. Giancarlo Comi
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Competing interests

Professor Comi has received speaker's honoraria from Teva, Bayer Schering, Merck Serono and Biogen-Dompé, and is serving on scientific advisory boards for Teva, Bayer Schering and sanofi-aventis.

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Comi, G. Clinically isolated syndrome: the rationale for early treatment. Nat Rev Neurol 4, 234–235 (2008). https://doi.org/10.1038/ncpneuro0772

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