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Controversies in Neurology
April 2006

Most Patients With Multiple Sclerosis or a Clinically Isolated Demyelinating Syndrome Should Be Treated at the Time of Diagnosis

Author Affiliations

Author Affiliations: Departments of Neurology and Ophthalmology (Drs Frohman, Stuve, and Racke), University of Texas Southwestern Medical Center at Dallas (Dr Frohman); Department of Neurology, Charles University, Prague, Czech Republic (Dr Havrdova); Department of Neurology, Mount Sinai School of Medicine, New York, NY (Dr Lublin); Department of Radiology, Vrije Universiteit Medical Center, Amsterdam, the Netherlands (Dr Barkhof); Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Dr Achiron); Department of Neurology, Guy's Hospital, London, England (Dr Sharief); Department of Neurology, Stanford University, Stanford, Calif (Dr Steinman); Department of Neurology, Brigham and Women's Hospital, Harvard University, Boston, Mass (Dr Weiner); Department of Neurology, University of California, Irvine (Dr Olek); Buffalo Neuroimaging Analysis Center, The Jacobs Neurological Institute, Department of Neurology, University of Buffalo, Buffalo, NY (Dr Zivadinov); Department of Neurology, University of Colorado, Denver (Dr Corboy); Department of Pathology, Albert Einstein College of Medicine, Bronx, NY (Dr Raine); Department of Biostatistics, University of Alabama, Tuscaloosa (Dr Cutter); Research and Clinical Programs, National Multiple Sclerosis Society, New York (Dr Richert); Department of Neurology, Scientific Institute and University Ospedale San Raffaele, Milan, Italy (Dr Filippi).



Arch Neurol. 2006;63(4):614-619. doi:10.1001/archneur.63.4.614

The question “How early should multiple sclerosis (MS) be treated?” implies that we can accurately pinpoint the onset of the disease. At the time of the first clinically isolated demyelinating syndrome (CIS), many patients describe antecedent symptoms that suggest an earlier disease onset. Further, the occurrence of occult disease prior to the onset of clinical symptoms is corroborated by the observation that up to 80% of individuals with a CIS who go on to have confirmed MS (clinically definite MS [CDMS]) already had radiographic evidence of MS at the time of initial examination.1-8 Unfortunately, the true onset of MS cannot be determined in most patients, suggesting that “early” treatment is, for most, not early at all.

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