1st Aug, 2002
Real Living with Multiple Sclerosis
WHY IS SO MUCH EMPHASIS being put on magnetic resonance imaging (MRI) and what should you be doing about it? Some neurologists seem to rely heavily on MRI, because it's a tangible indicator of intangibles. But what's it really telling anyone?
MRI takes a "snapshot" of any little layers of your brain that the doctor wants to see. It also "photographs" the spinal cord, but not nearly so successfully, because of technical limitations. As a medical test, it's easy for the patient: There's no fasting, no undressing, no pain (except for the injection of dye), and no unpleasantness if you're not claustrophobic. Yes, it's noisy, but in a monotonous way that might make you sleepy. I've had two MRIs done in the past 9 years. Each time I couldn't have been treated better. Although there was very little human contact or conversation during my visits, I was convinced that my wellbeing and comfort were as important to the technicians as my exact placement within the machine.
After the MRI, the discomfort can begin. This isn't physical unease; it's the wait, not to mention hearing (and perhaps seeing) results that you can't really comprehend.
Imaging is an extremely specialized, evolving science with its own vocabulary. Because it picks up abnormalities, it's not particularly reassuring. That's in part because brains change with age, not just with disease. So, as you spend time with MS-lots of time, because MS goes on for decades-the MRI changes produced by MS appear on a backdrop of normal brain atrophy and increasing irregularities.
If MRI is being used to diagnose your MS, it may convince your doctor and you that you really do have MS and that you should be receiving drug treatment. MRI also convinces insurance companies. In this case, while it may be horrifying to think that there are "holes in my brain," MRI serves a constructive purpose for the patient. Because MS usually progresses fairly slowly, ideally there will be time to adjust and to accept while concurrently receiving the benefit of information and medication.
If your MRI takes place midstream in your course of MS, it can be a familiar but somewhat ominous process. How can you feel good about even one "spot" on your slightly shrunken brain? Suppose the spot has grown larger than it was before, whenever "before" was? Suppose you have six new spots in six new places? How worrisome is all this?
Even experts on MS don't clearly understand what MRI scans represent for the individual patient. Scans have been particularly useful in clinical trials. They demonstrate brain changes over time in large groups of patients who are taking medications or placebos. Their use in these situations has been standardized and quantified to provide very exact comparative measurements for purposes of the trials. OK, but how does this apply if you're not a research participant?
Don't Feel Doomed
MRI applies only indirectly. You may benefit eventually from new research, but that's a slow process. More likely, your neurologist may use MRI to assess whether your treatment is helping you adequately. Accordingly, your neurologist may be motivated in part by your MRI to make changes in your treatment. But it's the clinical picture-how you function when examined (your eyes, strength, balance, and so on)-that speaks 1,000 words. As Randall Schapiro, MD, has publicly said, "You have to treat the person, not the MRI."
MS is a mysterious disease of frustrations and paradoxes. There are many blank spaces left in science's understanding of this disease. That's where hope may reside.
MRI doesn't tell your fortune. Lesions change over time, sometimes for
the better. Even when the actual nerve, not just its coating, has been
damaged, brains can learn new tricks and so can you. Don't feel doomed
by your MRI. It's simply a picture of how your brain was on one particular
day. It might not be any more lastingly important than wearing mismatched
socks for a formal portrait.
© 2002 Real Living with Multiple Sclerosis