As physicians how do we counsel our patients with clinically isolated syndrome (CIS) when they ask, ‘what is the benefit of injecting disease-modifying agents (DMAs) over many years? What disability will they prevent in my future?’ In this debate, we will provide three core points supporting the concept that a watchful waiting approach (annual neurological evaluation and magnetic resonance imaging of the head (with gadolinium) at least for the first few years after diagnosis) for most patients with CIS represents appropriate medical care.
Abou ZeidNEPittockSJ. Clinically isolated syndromes. In: LucchinettiCHohlfeldR (eds) Multiple Sclerosis 3: Blue Books of Neurology. Saunders Elsevier, 2010, pp. 206–218.
2.
FisnikuLKBrexPAAltmannDR. Disability and T2 MRI lesions: a 20-year follow-up of patients with relapse onset of multiple sclerosis. Brain2008; 131: 808–817.
3.
PolmanCHReingoldSCBanwellB. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol2011; 69: 292–302.
4.
PittockSJ. Interferon beta in multiple sclerosis: how much BENEFIT?Lancet2007; 370: 363–364.
5.
KapposLFreedmanMSPolmanCH. Long-term effect of early treatment with interferon beta-1b after a first clinical event suggestive of multiple sclerosis: 5-year active treatment extension of the phase 3 BENEFIT trial. Lancet Neurol2009; 8: 987–997.
6.
ComiGMartinelliVRodegherM. Effect of glatiramer acetate on conversion to clinically definite multiple sclerosis in patients with clinically isolated syndrome (PreCISe study): a randomised, double-blind, placebo-controlled trial. Lancet2009; 374: 1503–1511.
7.
PittockSJ. Uncertain BENEFIT of early interferon beta-1b treatment. Lancet Neurol2009; 8: 970–971.
8.
NoyesKBajorskaAChappelA. Cost-effectiveness of disease-modifying therapy for multiple sclerosis: a population-based study. Neurology2011; 77: 355–363.
