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KMID : 1022820100010020044
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Journal of Multiple Sclerosis and Neuroimmunology
2010 Volume.1 No. 2 p.44 ~ p.51
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Early Diagnosis and Treatment of Multiple Sclerosis
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Kim Su-Hyun
Kim Woo-Jun
Kim Ho-Jin
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Abstract
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A clinically isolated syndrome (CIS) is often the first symptom of multiple sclerosis (MS). The classic syndromes include unilateral optic neuritis, partial myelitis, and brain stem syndromes. Most patients with CIS who are likely to develop MS have the MRI activity, with MRI lesions often outnumbering clinical events. MRI is a powerful tool in assessing CIS not only for assessing whether the clinical symptoms are due to inflammation, but also to establish an early diagnosis of MS prior to the development of a second diagnostic clinical attack. However, not all CIS patients will develop clinically definite MS (CDMS), nor are all presenting symptoms of MS necessarily classic. Therefore, MRI results need to be interpreted in the context of the clinical symptoms and other paraclinical tests. It is now possible to diagnose patients with MS earlier than previously due to the integration of MRI parameters into the diagnostic criteria. This provides a window of opportunity to treat patients with disease-modifying drugs before there is extensive axonal loss and disability has emerged. There are a number of reasons to believe that such early treatment is particularly beneficial. First, the early course influences long-term disease evolution. The immunopathological studies have shown that the irreversible axonal damage that underlies accumulation of disability occurs very early in the course of the disease. In addition, natural history studies demonstrate that frequent relapses and accumulation of a high T2 lesion load in the first years following diagnosis are predictive of long-term disability outcome. Second, the four clinical studies have demonstrated that treatment initiated after a first demyelinating event suggestive of MS, with MRI evidence of disease activity, reduced the risk of progression to CDMS compared with placebo. All of these studies show that treating before you can diagnose MS has benefits on relapse rates and MRI parameters. However, the long term benefit which means improvement of neurological disability is still less clear and linical trials provide information on groups of individuals, but physicians treat individuals not groups based on the results. Therefore, choosing the right time to initiate the treatment should be decided by individual basis, rather than a ‘one size fits all’ approach.
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KEYWORD
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Multiple sclerosis, Clinically isolated syndrome, Early diagnosis, Early treatment, Magnetic resonance image, Disease modifying therapy
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