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Clinically isolated syndrome: Diagnosis and risk of developing clinically definite multiple sclerosis

J López-Gómez1, B Sacristán Enciso2, M A Caro Miró3

  • 1Unidad de Proteínas, Servicio de Análisis Clínicos, Hospital Universitario de Badajoz, Badajoz, Spain.

Neurologia
|October 20, 2023
PubMed
Abstract

Insights

Diagnosing clinically isolated syndrome (CIS) and predicting multiple sclerosis (MS) progression is crucial. Combining MRI and oligoclonal IgG bands aids early MS diagnosis and risk assessment.

Area of Science:

  • Neurology
  • Neuroimmunology
  • Biomarker Discovery

Background:

  • Multiple sclerosis (MS) often begins as clinically isolated syndrome (CIS).
  • Accurate CIS diagnosis and prognosis are vital for patient outcomes, as early progression is linked to poorer long-term prognosis.

Purpose of the Study:

  • To review diagnostic variables for improving accuracy in CIS.
  • To evaluate predictors of CIS progression to clinically definite MS.

Main Methods:

  • Literature review assessing magnetic resonance imaging (MRI) utility.
  • Evaluation of biofluid markers: oligoclonal IgG/IgM bands, CSF kappa free light-chain (KFLC) index, CSF/serum neurofilament light chain (NfL), and CSF/serum chitinase 3-like protein 1 (CHI3L1).

Main Results:

  • Codetection of oligoclonal IgG bands and MRI lesions shortens diagnostic time and indicates high MS progression risk.
  • Specific thresholds for KFLC index (>10.6) and CSF NfL (>1150 ng/L) predict 40-50% one-year MS progression.
  • Elevated serum CHI3L1 (>33 ng/mL) or presence of lipid-specific oligoclonal IgM bands predict MS onset within one year in 90-100% of CIS patients.

Conclusions:

  • Combined MRI and oligoclonal IgG band detection improves CIS diagnosis and identifies high-risk patients.
  • Specific biomarkers like KFLC index, NfL, CHI3L1, and lipid-specific IgM bands offer valuable prognostic information for CIS progression to MS.
Keywords:
Bandas oligoclonalesCadenas ligeras libres KappaChitinasa 3-like 1Chitinase 3–like protein 1Clinically isolated syndromeEsclerosis multipleKappa free light-chainsMagnetic resonance imagingMultiple sclerosisNeurofilament light chainNeurofilamentos de cadenas ligerasOligoclonal bandsResonancia magnéticaSíndrome clínico aislado

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