Do not treat from CIS onset: evaluate disease course and prognosis first--yes.

ABSTRACT

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.