Clinically Isolated Syndrome and Early Relapsing Multiple Sclerosis

Luanne M. Metz, MD, FRCPC Multiple Sclerosis and Other CNS Inflammatory Diseases p. 670-688 June 2019, Vol.25, No.3 doi: 10.1212/CON.0000000000000729
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PURPOSE OF REVIEW: This article reviews management of clinically isolated syndrome and early relapsing-remitting multiple sclerosis (MS). It provides a general approach to patient management and determination of prognosis, reviews first-line disease-modifying therapies, and provides an approach to treatment selection.

RECENT FINDINGS: Revision of the MS diagnostic criteria allows an earlier MS diagnosis, which reduces diagnostic uncertainty and often allows additional treatment options. Identification of factors that influence disease activity and progression highlights the importance of counseling patients about behavior modifications that, along with disease-modifying therapy, may improve long-term outcomes. Recommended lifestyle modifications include smoking cessation, vitamin D supplementation, a healthy diet, maintaining a healthy weight, remaining active, and management of cardiovascular risk factors. Identifying individuals at high risk for future disability allows them to make informed decisions about the use of highly effective, higher-risk disease-modifying therapies.

SUMMARY: Patients with clinically isolated syndrome, even those with only dissemination in space but not dissemination in time, and patients with relapsing-remitting MS and disease activity within the prior 2 years, are at high risk of disease activity within the next 2 years. Lifestyle modification suggestions and disease-modifying therapy should be considered. Treatment decisions should be made in collaboration with patients using the shared decision-making approach.

Address correspondence to Dr Luanne M. Metz, Foothills Hospital, 1403 29th St NW, Calgary, Alberta, Canada T2N 2T9, lmetz@ucalgary.ca.

RELATIONSHIP DISCLOSURE: Dr Metz receives research/grant support from Alberta Innovates Health Solutions (201300669) and the Multiple Sclerosis Society of Canada.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Metz was the principal investigator on a phase 3 study on the use of minocycline for the treatment of clinically isolated syndrome.

© 2019 American Academy of Neurology.