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Patients presenting with clinically isolated syndromes (CIS) compatible with MS create a diagnostic and therapeutic dilemma. Although some CIS are self-limited and do not require long-term treatment, others are the first clinical manifestation of MS, where, in light of recent studies,1,2⇓ one would consider starting disease-modifying therapies.3 However, identifying which patients have MS has been difficult. Until recently, clinicians used diagnostic criteria developed by Schumacher et al.4 in 1965 based on physical examination findings alone; these criteria were modified in 1983 by Poser et al.5 to include evoked response testing and CSF examination. This meant that diagnosis of MS could not be made until at least two clinical events occurred.4 With the advent of MRI, it has been shown that over 80% of patients with CIS and MRI lesions go on to be diagnosed with MS, whereas approximately 20% have self-limited processes.6 In July 2001, the International Panel on MS Diagnosis, chaired by Ian McDonald, made recommendations that built on older diagnostic criteria by incorporating MRI findings.7 The recommendations included criteria for determining whether lesions on brain MRI are abnormal and whether these abnormalities satisfy the criteria for dissemination in time and space. The outcome of a diagnostic evaluation has been simplified to “MS,” “possible MS,” or “not MS.” These criteria now allow a diagnosis of MS to be made in a patient presenting …
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