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Clinical Research of Clinically Isolated Syndromes

Author: ZhangJinNi
Tutor: LiZhuYi；LiHongZeng
School: Fourth Military Medical University
Course: Neurology
Keywords: Clinically isolated syndrome Multiple sclerosis Magnetic resonance imaging Cerebrospinal fluid Evoked potentials Extended dysfunction Status Scale score
CLC: R744
Type: Master's thesis
Year: 2009
Downloads: 145
Quote: 0
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Abstract

Clinically isolated syndrome (CIS) is the first attack of the central nervous system inflammatory demyelinating event, usually manifested monocular retrobulbar optic neuritis, the isolated brainstem symptoms, or part of the spinal cord symptoms. 30% -70% of the CIS final progression to multiple sclerosis (MS), 85% of MS onset manifested as CIS. CIS is generally believed that the first attack of demyelination events, its clinical manifestations and MRI both showed a part of the lesion. View CIS isolated in time, but in the space can be multiple possible that there are several parts of the lesion in the first attack. Visual evoked potential of the high sensitivity of the CIS optic neuropathy, brainstem auditory evoked potential and somatosensory evoked potential sensitivity of brain parenchymal lesions was significantly lower than the MRI examination. CSF oligoclonal band predict the CIS independent risk factors for recurrence. A number of studies, of multifocal damage and pyramidal tract involvement and baseline MRI abnormalities and so prompt CIS poor prognosis. McDonald standard MRI to determine the time and space of multiple indicators significantly improve the rate of MS early diagnosis, but also for the the early judgment CIS provides a more sensitive indicator of the prognosis. Drug clinical trials in recent years made more progress, with interferon beta Grammer immunomodulatory agents remission therapy (DMT) is considered to be the optimization of treatment programs, early diagnosis of CIS, to assess their progress to the risk of MS and select individualized treatment, help prevent MS progression and reduce disability. Domestic fewer clinical studies of CIS. This topic is a retrospective analysis of hospitalized cases of complete data MS early manifestation of the CIS cases of clinical characteristics of departments, evoked potentials, cerebrospinal fluid tests, MRI examination, treatment extended dysfunction Status Scale (EDSS) score as the main line, relevant literature and research combined with the field of dynamic and summarized to explore the clinical manifestations of the CIS, MRI characteristics, diagnosis and treatment of the situation and prognostic factors. The topics collected MS cases, 82.3% in the early performance of the CIS. 89.9% of CIS patients with acute or subacute onset, 51.9% performance for spinal cord injury, 21.5% for optic neuritis symptoms, 13.9% for single brainstem symptoms. 41.1% of magnetic resonance imaging examinations showed \Extent of disease in the two vertebral segments of the spinal cord CIS 45.1%, 81.7% independent lesions in the sagittal length of not more than two vertebral height, 89.0% in the axial does not exceed 1/2 of the transverse diameter of the spinal cord. Number of baseline MRI lesions, EDSS score positive correlation between area with diagnosed MS. Accounted for 96.1%, after the first episode of corticosteroid treatment can relieve EDSS scores before and after treatment were significantly different, depending on which neuritis type effect than significant. The clinical manifestations of the CIS has diversity and variability. When clinical symptoms of patients with white matter damage, should be actively looking for the imaging and laboratory evidence, such as cerebrospinal fluid IgG, oligoclonal bands and evoked potentials check carefully identify diagnostic. Higher positive rate of MRI in the CIS, is the most sensitive, specific and accurate inspection, the most valuable basis for the assessment of prognosis and efficacy. The McDonald diagnostic new standard provides a more simple, accurate indicators to predict the prognosis of the CIS. Early intravenous corticosteroids can effectively alleviate acute symptoms, but did not markedly delay the CIS progress. CIS progress DMT can effectively reduce the risk of MS, reducing MRI lesions to prevent progression.

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