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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EClinically isolated syndrome (CIS) refers to the first neurologic episode in which a person experiences multiple sclerosis (MS)-related symptoms. The diagnosis of CIS is reserved for patients who do not meet the criterion of dissemination in space and\/or dissemination in time clinically and in the first magnetic resonance image. This article debates whether or not patients with CIS should be treated.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ESystemic Atrophies\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeuroimaging\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDemyelinating Diseases\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EClinically isolated syndrome (CIS) refers to the first neurologic episode in which a person experiences multiple sclerosis (MS)-related symptoms. According to the McDonalds 2010 criteria, MS can be diagnosed in patients with only one clinical episode. The diagnosis of CIS is reserved for patients who do not meet the criterion of dissemination in space and\/or dissemination in time clinically and in the first magnetic resonance image (MRI). In this session, presenters debated whether or not patients with CIS should be treated.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EHans-Peter Hartung, MD, Heinrich Heine University, D\u00fcsseldorf, Germany, presented the case that patients with CIS should be treated. In the MAGNIMS study [Filippi M et al. \u003Cem\u003EArch Neurol\u003C\/em\u003E 2009;], patients had a first MRI at 1.3 months and a second one at 5.0 months. With regard to conversion to clinically definite MS (CDMS), the two MRIs demonstrated 47% and 43% sensitivity, 88% and 87% specificity, and 76.5% and 75% accuracy, respectively. The investigators concluded that a single MRI may suffice to identify a subset of CIS patients with a high risk of developing CDMS, even when it is performed within the first three months after the onset of symptoms.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EStudies have shown that a shorter first inter-attack interval and incomplete recovery from the first attack are predictors of long-term disability in patients with relapsing-remitting MS (RRMS). A 20-year study found that an early high rate of MRI disease activity is associated with long-term disease progression. Numerous studies show that axonal damage occurs early in MS and is irreversible. Several Phase 3 trials of early therapy for CIS have been completed. The CHAMPS, ETOMS, BENEFIT, and PRECISE trials demonstrated that significantly fewer treated CIS patients versus placebo patients had CDMS at 2 years (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [Jacobs LD et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2000; Comi G et al. \u003Cem\u003ELancet\u003C\/em\u003E 2001; Kappos et al. \u003Cem\u003ENeurology\u003C\/em\u003E 2006; Comi G et al. \u003Cem\u003ELancet\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/2\/17\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Studies in CIS Populations.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1400501163\u0022 data-figure-caption=\u0022Studies in CIS Populations.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/2\/17\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/2\/17\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/2\/17\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13969\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003EStudies in CIS Populations.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from HP Hartung, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EProf. Hartung concluded that irreversible axonal damage occurs early and has an impact on the development of disability. Disease-modifying therapy seems to be more effective if used earlier.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EKarl Vass, MD, University of Vienna, Vienna, Austria, argued that patients with CIS should not be treated early for the following reasons: the definition of CIS is vague; not every patient with CIS will develop MS; many patients will develop only mild disease; and many patients will not accept immediate treatment. In a long-term follow-up of patients with CIS, among those with an abnormal MRI at baseline, 83% had converted to CDMS at 10 years. Only 50% of patients had developed CDMS within 2 years. Further, it takes a long time for significant disability to occur, which usually is preceded by additional relapses or more MRI activity [Confavreux C. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2000].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EIn the CIS studies, ETOMS, CHAMPS, REFLEX, BENEFIT, and PRECISE [Comi G et al. \u003Cem\u003ELancet\u003C\/em\u003E 2001; Jacobs LD et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2000; Kappos L et al. \u003Cem\u003ENeurology\u003C\/em\u003E 2006; Kappos L et al. \u003Cem\u003ELancet\u003C\/em\u003E 2007; Comi G et al. \u003Cem\u003ELancet\u003C\/em\u003E 2009], 30% to 60% of the patients already had MS according to the McDonald 2010 Criteria. These study results provide insufficient evidence for efficacy of disease-modifying therapy in \u201cnew\u201d CIS patients. Finally, clinical experience shows that many patients are not ready to begin therapy after a diagnosis of CIS.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EProf. Vass concluded that not every patient with CIS should be treated; more than 50% do not need disease-modifying therapy, which is insufficiently effective and expensive.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/2\/17.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzni7q\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzni7q\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}