Multiple sclerosis can’t be cured, and through the progression of the illness can be slowed with certain medications and therapies, there is no way to stop it.
Sometimes, however, the symptoms that relate to multiple sclerosis aren’t pointing in that direction. In these cases, a diagnosis of a clinically isolated syndrome, or CIS, may come into play. What is CIS, and how does it differ from multiple sclerosis? Why would it be a better, or less worrisome diagnosis?
Similarities of the conditions
First, it’s important to know why a patient who doesn’t have MS might present with the same symptoms and have cause for concern. With both MS and clinically isolated syndrome, the patient will have a very specific set of symptoms. While those symptoms may not appear in the same order or may differ in severity, the early symptoms of either disease are:
- Feelings of limbs or face being “asleep”, numb or tingling
- Blurred vision, eye pain, or other ocular issues
- Muscle weakness or pain
- Vertigo, dizziness, trouble balancing, and difficulty walking
- Stiffness and muscle spasms, especially in the legs
- Extreme fatigue
- Speech issues and memory deficiency
- Bladder issues, such as frequent and sudden need to urinate or loss of control
- Sudden onset of depression and extreme mood swings
What causes clinically isolated syndrome and multiple sclerosis?
Both diseases begin the same way as well. It’s an autoimmune problem, which means that the immune system reacts to something that belongs in the body the same as it would to something foreign and unwelcome (like a virus), creating antibodies to attack the substance.
In the case of CIS and MS, the immune system attacks the important protective lining around the nerves in the brain and the spinal cord, a substance called myelin. Under this attack, the nerves become inflamed and can also be damaged, either of which prevents them from firing and signaling properly. This is the cause behind the symptoms.
What is the difference between clinically isolated syndrome and multiple sclerosis?
The biggest difference between a clinically isolated syndrome and multiple sclerosis is that MS is a pattern of relapse and remit, which means the symptoms arrive, then fade, and then it happens again. Any patient who experiences bouts with these symptoms (and undergoes testing to confirm the presence of the antibodies that cause them) more than once will likely be diagnosed with MS.
However, in clinically isolated syndrome, the symptoms occur, fade, and never return. It is a one-time attack on the nervous system, not a continued ailment. While doctors are uncertain of why CIS could happen, they theorize that perhaps a virus is at the center of the attack on the system.
Things to rule out
Before fearing the worst, some other ailments with similar symptoms should be ruled out, including:
- Certain problems with blood vessels
- Lyme disease
Since all of these could be serious issues as well, it’s important to make sure the symptoms aren’t related to one of these as opposed to CIS or MS. One factor that points toward clinically isolated syndrome or multiple sclerosis is that the symptoms last at least 24 hours and usually longer prior to receding.
How is clinically isolated syndrome diagnosed?
Talking to a physician about the symptoms experienced and medical history can identify the markers of CIS (or, if there have been multiple onsets, MS). A physical exam will likely follow the discussion, but a doctor will want to run tests. Most likely, an MRI of the head and spine will be ordered to look at potential inflammation or nerve damage that could appear as a result of the immune system attack.
Doctors can also use a spinal tap, taking a sample of spinal fluid to analyze. If the antibodies produced to attack myelin are present, depending on whether symptoms have presented once or multiple times, a diagnosis of CIS or MS will probably be made.
Does clinically isolated syndrome turn into multiple sclerosis?
There is no way to know for sure if someone who experiences clinically isolated syndrome will later have a relapse and be diagnosed with MS. However, if the doctor finds brain lesions when performing an MRI to look for damage, there is a higher chance that the patient will develop multiple sclerosis in the next few years.
Other risk factors for experiencing CIS or getting MS are good markers to look for. Women are three times as likely as men to experience CIS or get MS. In addition, people between the ages of twenty and forty are at the highest risk for diagnosis of either disease.
Differences in treatment between clinically isolated syndrome and multiple sclerosis
Because CIS is temporary and doesn’t last long most of the time, and because it is typically not expected to recur, a doctor will likely only prescribe something such as a short term steroid treatment to help with recovery and easing the burden of symptoms. In addition, a follow up MRI may be ordered for three to six months later to see if there is additional damage or progression of the condition.
In some cases, if brain lesions are found, or if MS is diagnosed immediately, other medications may be prescribed. Some are pills that can be taken, while others are injections or infusions that help reduce the occurrence of symptoms (relapse) and keep them from being as severe when they do flare up. These medications have side effects that a physician should explain prior to prescribing them. In some cases, doctors believe that treating CIS with these medications early on can help prevent it from progressing into multiple sclerosis in the future.
While clinically isolated syndrome and multiple sclerosis are essentially the same disease with the same cause and symptoms, those who only experience the onset of symptoms once and not repeatedly are more likely to be diagnosed with CIS. At the same time, a patient who has had CIS and has a recurrence of symptoms could be advancing into a diagnosis of MS. Keeping track of symptoms, a frequency of a relapse, and intensity of those symptoms can help determine the best treatment and line of defense for the future.