Symptoms of the clinically isolated syndrome (CIS) are similar to those of multiple sclerosis (MS) relapse.
Clinically isolated syndrome (CIS) is a part of the multiple sclerosis (MS) spectrum. Having CIS, however, does not mean that the person will inevitably develop MS. The exact cause of CIS is unknown; however, most experts agree that autoimmune mechanisms do not play an exclusive role in the development of CIS.
Unfortunately, we do not know what triggers CIS episodes. It is common in young women between the ages of 20 and 40 years. The etiology appears to be multifactorial.
The following three factors play a role in the development of CIS:
- Genes (though not directly inherited): CIS is often seen in individuals who have family members affected by MS.
- Unknown environmental triggers: This includes exposure to sunlight, environmental toxins, stress, and exposure to viruses.
- Autoimmune etiology
What is clinically isolated syndrome?
Clinically isolated syndrome (CIS) refers to the first episode of neurologic symptoms that may potentially develop into multiple sclerosis (MS). The symptoms of CIS last at least 24 hours and are caused by inflammation or demyelination (loss of the myelin sheath that insulates the nerve cells) in the central nervous system.
An episode of CIS may or may not develop into full-blown MS. The risk of developing MS is higher (up to 80 percent) if the person has positive findings of demyelination on magnetic resonance imaging (MRI).
If the person presents with only symptoms with no MRI findings, the lifetime risk of developing MS is around 20 percent.
What is the difference between clinically isolated syndrome and multiple sclerosis?
Symptoms of the clinically isolated syndrome (CIS) are similar to those of multiple sclerosis (MS) relapse, except CIS is a single episode and may never happen again.
Symptoms of CIS include:
- Numbness or tingling in the extremities
- Vision problems, such as double vision or nystagmus (abnormal side to side or up to down movement of the eye)
- Severe facial pain
- Severe shooting pains or shock-like sensations in the upper arm area and the back
- Spasticity or stiffness of the muscles
- Difficulty controlling the bladder or bowel movement
- Difficulty with walking and coordination
- Muscle weakness
- Lower limb paralysis
- Sexual dysfunction
How do I get rid of CIS?
Unfortunately, you may not get rid of the clinically isolated syndrome (CIS) as easily as the general cold or flu. Lifestyle measures such as stress management, meditation, quitting smoking and alcohol, avoidance of extremes of temperatures and heat, avoidance of certain drugs, and frequent illnesses may help avoid CIS flares.
Make sure you take all seasonal vaccines and flu shots. Despite fears that m-RNA vaccines may cause multiple sclerosis (MS) or CIS flare, experts advise people with MS or a history of CIS to get the Pfizer or Moderna vaccine to protect themselves against Covid-19 after consulting their healthcare practitioner.
An acute episode of CIS is managed by intravenous glucocorticoid therapy (just like an MS flare). Generally, the therapy meant for MS – DMT (Disease-Modifying Therapy for MS) is not administered to patients with CIS, unless the doctor observes severe demyelination on magnetic resonance imaging (MRI).
Monitoring and follow-up every three to six months is the cornerstone of CIS therapy. Your doctor will re-do your MRI to check for new lesions, as well as worsening of your symptoms (if any). If any of the serial brain MRI scans show the development of “hyperintense” or bright lesions characteristic of MS in at least two of four areas, your doctor may start therapy with DMT.
The most effective drugs for CIS management include interferons, glatiramer acetate, and teriflunomide. These drugs may be needed to be taken for the long term, after which your doctor may decide to taper or stop them once you have had a long symptom-free interval.
