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Controversies in Neurology |

Most Patients With Multiple Sclerosis or a Clinically Isolated Demyelinating Syndrome Should Be Treated at the Time of Diagnosis

E. M. Frohman, MD, PhD; E. Havrdova, MD; F. Lublin, MD; F. Barkhof, MD; A. Achiron, MD; M. K. Sharief, MD; O. Stuve, MD, PhD; M. K. Racke, MD; L. Steinman, MD; H. Weiner, MD; M. Olek, DO; R. Zivadinov, MD, PhD; J. Corboy, MD; C. Raine, PhD, DSc; G. Cutter, PhD; J. Richert, MD; M. Filippi, MD
Arch Neurol. 2006;63(4):614-619. doi:10.1001/archneur.63.4.614.
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The question “How early should multiple sclerosis (MS) be treated?” implies that we can accurately pinpoint the onset of the disease. At the time of the first clinically isolated demyelinating syndrome (CIS), many patients describe antecedent symptoms that suggest an earlier disease onset. Further, the occurrence of occult disease prior to the onset of clinical symptoms is corroborated by the observation that up to 80% of individuals with a CIS who go on to have confirmed MS (clinically definite MS [CDMS]) already had radiographic evidence of MS at the time of initial examination.18 Unfortunately, the true onset of MS cannot be determined in most patients, suggesting that “early” treatment is, for most, not early at all.

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