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Clinically Isolated Syndrome versus MS

By Matt Cavallo

When I was being diagnosed with multiple sclerosis, I experienced an acute onset of transverse myelitis. TM is the inflammation of the spinal cord which can cause symptoms including: pain, weakness, numbness, tingling, problems walking, paralysis, bladder and bowel dysfunction. In my case, I experienced problems walking, numbness, tingling, and bladder issues. I was hospitalized and treated with steroids to help reduce the inflammation.
 
Upon my discharge from the hospital, I participated in physical therapy, both aquatic and in the gym, to learn how to walk again. When I could walk again, I thought that the TM was behind me and that I would resume my life as normal. However, when I followed up with my neurologist, he diagnosed me with probable MS.
 
I was confused by the diagnosis. Did it mean that I probably had MS or probably not? What he told me was that I had a clinically isolated episode of TM and we wouldn’t know until my next exacerbation whether or not the diagnosis of MS was confirmed. Given my diagnosis, I wanted to learn more about Clinically Isolated Syndrome.
 
Clinically Isolated Syndrome is the first episode of neurologic symptoms that a person may experience. CIS symptoms last at least twenty-four hours and a person may experience one or more of the following symptoms:
 
* Numbness or tingling in the arms, legs, or face
* Slurred speech
* Blurred vision or other eye problems
* Muscle weakness
* Vertigo or dizziness
* Problems with balance or walking
* Stiffness or muscle spasms
* Fatigue
* Pain
* Poor memory
* Depression or mood swings
* Bladder, bowel, or sexual problems
 
CIS symptoms can either be monofocal or multifocal. Monofocal means that a person experiences one symptom, like TM, typically caused by one lesion. Multifocal means that a person experiences more than one symptom, like TM and optic neuritis, typically caused by multiple lesions in multiple locations. In my case, I had TM which meant that I had one lesion on my spine creating numbness, tingling, problems walking and bladder problems.
 
CIS symptoms do not last that long and are treatable. A person may be prescribed steroids or other medication to manage the inflammation. Physical, occupational, and speech therapy may also be recommended for functional improvement after an episode of CIS. In my case, I was hospitalized for five days and treated with IV solu-medrol. Solu-medrol was the steroid used to help decrease the inflammation in my spine. As discussed earlier, I also followed-up with physical and aquatic therapy to learn how to walk again.
 
Not all people who have CIS will develop multiple sclerosis. When a person is diagnosed with CIS and has an MRI with lesions that look similar to MS lesions, that person has a 60-80 percent risk of developing MS. If MS lesions are not revealed on an MRI, the risk of developing MS drops to 20 percent. According to the 2010 revisions to the diagnostic criteria for MS, the diagnosis of MS can be made when CIS is accompanied by MRI findings (old lesions or scars) that confirm that an earlier episode of damage occurred in a different location in the central nervous system. New diagnostic breakthroughs in the areas of MRI and blood testing could help accelerate the diagnosis of MS.