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Clinical course of MS. The course of MS can be divided into clinically isolated syndrome (CIS) and clinically defined RPMS. Radiologically isolated syndrome (RIS) is defined by incidental imaging findings suggesting inflammatory demyelination in the absence of clinical signs or symptoms, while CIS is identified as the first clinical presentation of the disease. SPMS is diagnosed retrospectively by a history of gradual worsening after an initial relapsing disease course [53].
