More MS news articles for Nov 2001

How Often Should MRI Be Performed on a Patient With Primary Progressive Multiple Sclerosis?

http://neurology.medscape.com/Medscape/Neurology/AskExperts/MS/2001/11/NEUR-ae103.html

Question

How often should a patient with primary progressive multiple sclerosis undergo MRI?

Response
from Rohit Bakshi, MD, 11/20/01

There are 4 recognized clinical subtypes of MS: relapsing-remitting (RR), secondary progressive (SP), primary progressive (PP), and progressive relapsing (PR). A panel of experts published consensus guidelines for the MS community on how to define these clinical categories.[1] RR-MS includes acute relapses that are followed by some degree of recovery; the patient's disability does not worsen between relapses. SP-MS is typified by sustained progression of physical disability occurring separately from relapses, and develops in patients who previously had RR-MS; patients with SP-MS may or may not continue to experience superimposed relapses. PP-MS is defined as progression of disability from onset without superimposed relapses. When PP patients develop acute relapses well after the disease onset, they are classified as having PR-MS.

PP-MS has been the subject of several excellent articles focusing on diagnostic criteria and MRI manifestations.[2-11] Most experts agree that MRI of the brain is sensitive in identifying brain lesions in these patients, with a sensitivity exceeding 90%. Many authorities feel that brain MRI lesions in PP-MS look similar to the other MS subtypes, although there is some debate. MRI of the spine is also useful in identifying spinal cord lesions in PP-MS, which seem to occur less commonly than in patients with SP-MS, but may contribute to the clinical picture. MRI of the brain and spinal cord are also useful for identifying and following atrophy in PP-MS patients, which may be especially important in predicting the development of physical and cognitive disability.

There are no clear guidelines as to how often an MS patient should have serial MRI studies once the diagnosis has been established. I know of no reason why the strategy for frequency of MRI should differ among the various MS subtypes, including PP-MS. In my practice, I use enhanced MRI of the brain, cervical, and thoracic spinal cord routinely at 1- or 2-year intervals to follow clinically stable patients. Depending on patient preference I might do these more or less often. I believe that MRI complements the information obtained by clinical evaluation and helps to guide treatment decisions. I perform MRI more frequently in patients who are progressing or developing frequent attacks.

References

  1. Lublin FD, Reingold SC, for the National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Defining the clinical course of multiple sclerosis: results of an international survey. Neurology. 1996;46:907-911.
  2. Bashir K, Whitaker JN. Clinical and laboratory features of primary progressive and secondary progressive MS. Neurology. 1999; 53:765-771.
  3. Comi G, Filippi M, Martinelli V, et al. Brain MRI correlates of cognitive impairment in primary and secondary progressive multiple sclerosis. J Neuro Sci. 1995;132:222-227.
  4. Filippi M, Rovaris M, Gasperini C, et al. A preliminary study comparing the sensitivity of serial monthly enhanced MRI after standard and triple dose gadolinium-DTPA for monitoring disease activity in primary progressive multiple sclerosis. J Neuroimaging. 1998;8:88-93.
  5. Filippi M, Campi A, Martinelli V, et al. Comparison of triple dose versus standard dose gadolinium-DTPA for detection of MRI enhancing lesions in patients with primary progressive multiple sclerosis. J Neurol Neurosurg Psychiatry. 1995;59:540-544.
  6. Filippi M, Iannucci G, Tortorella C, et al. Comparison of MS clinical phenotypes using conventional and magnetization transfer MRI. Neurology. 1999;52:588-594.
  7. Kremenchutzky M, Lee D, Rice GPA, Ebers GC. Diagnostic brain MRI findings in primary progressive multiple sclerosis. Multiple Sclerosis. 2000;6:81-85.
  8. Stevenson VL, Miller DH, Rovaris M, et al. Primary and transitional progressive MS. A clinical and MRI cross-sectional study. Neurology. 1999; 52:839-845.
  9. Stevenson VL, Miller DH, Leary SM, et al. One year follow up study of primary and transitional progressive multiple sclerosis. J Neurol Neurosurg Psychiatry. 2000;68:713-718.
  10. Thompson AJ, Montalban X, Barkhof F, et al. Diagnostic criteria for primary progressive multiple sclerosis: a position paper. Ann Neurol. 2000;47:831-835.
  11. Thompson AJ, Polman CH, Miller DH, et al. Primary progressive multiple sclerosis. Brain. 1997;120:1085-1096.
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