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Yıl:2015; Cilt: 52; Sayı: Ek 1>> Özet
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Nöropsikiyatri Arşivi; 2015;52(Ek 1):1-11
Klinik İzole Sendrom: Klinik Özellikleri, Ayırıcı Tanısı, Tanı ve Tedavisi
H Efendi
Kocaeli Üniversitesi, Kocaeli
Klinik izole sendrom (KİS), potansiyel multipl sklerozun klinik olarak ilk başlangıcını ifade eden bir terimdir. KİS, genellikle genç erişkinlerde görülür ve 2-3 hafta içinde hızlıca doruk seviyeye ulaşan akut veya sub-akut başlangıç gösterir. Multipl skleroz (MS) gelişen genç erişkinlerin %85’inde hastalık optik sinirlerin, beyin sapının veya spinal kordun akut klinik izole sendromu ile başlar. MRG’de klinik olarak sessiz beyin lezyonları görüldüğünde MS gelişme olasılığı yüksektir. KİS tanısına yönelik tek bir klinik özellik veya diagnostik test yeterli olmadığından, diagnostik kriter hem klinik hem de paraklinik çalışmaların kombinasyonunu içerir. McDonald ve arkadaşlarının Uluslararası Panelde hazırladıkları diagnostik kriterler zaman ve alan içinde dağılıma ilişkin MRG kanıtlarını bir araya getirdi. Böylelikle Klinik İzole Sendomu olan hastalarda kesin MS tanısı konabilmektedir. KİS, MS’in genellikle en erken klinik tablosuyken, KİS’li hastalarda yapılan araştırmalar hastalığın gidişatını etkileyebilecek erken dönem patolojik değişiklikler ve patogenetik mekanizmalarla ilgili yeni bir bakış açısı getirebilir. Tanıya yönelik iyileşmelerle ve hastalık modifiye edici MS tedavilerinin gelişiyle KİS’li hastalara karşı ilgi ve bu hastalarda yapılan araştırmalar artmıştır.
Clinically Isolated Syndromes: Clinical Characteristics, Differential Diagnosis, and Management
Clinically isolated syndrome (CIS) is a term that describes the first clinical onset of potential multiple sclerosis (MS). The term CIS is typically applied to young adults with episodes of acute or subacute onset, which reaches a peak quite rapidly within 2-3 weeks. In 85% of young adults who develop MS, onset occurs with an acute, CIS of the optic nerves, brainstem, or spinal cord. When clinically silent brain lesions are seen on MRI, the likelihood of developing MS is high. Because no single clinical feature or diagnostic test is sufficient for the diagnosis of CIS, diagnostic criteria have included a combination of both clinical and paraclinical studies. Diagnostic criteria from the International Panel of McDonald and colleagues incorporate MRI evidence of dissemination in time and space to allow a diagnosis of definite MS in patients with CIS. As CIS is typically the earliest clinical expression of MS, research on patients with CIS may provide new insights into early pathological changes and pathogenetic mechanisms that might affect the course of the disorder. With recent improvements in diagnosis and the advent of disease-modifying treatments for MS, there has been growing interest and research in patients with CIS.

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