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Serial magnetic resonance scanning in multiple sclerosis: a second prospective study in relapsing patients
E W Willoughby1, E Grochowski, D K Li
1Department of Medicine, University of British Columbia, Vancouver, Canada.
Annals of Neurology
|January 1, 1989
Summary
New brain lesions in multiple sclerosis (MS) patients are common, even without symptoms. Magnetic resonance (MR) scanning reveals these active lesions, suggesting MS is more active in early stages than previously thought.
Area of Science:
- Neuroscience
- Radiology
- Immunology
Background:
- Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system.
- Early-stage MS, particularly relapsing-remitting MS, can present with subtle or no clinical symptoms.
- The subclinical activity of MS is not fully understood.
Purpose of the Study:
- To investigate the occurrence and characteristics of new brain lesions in patients with mild relapsing-remitting multiple sclerosis using serial magnetic resonance (MR) scans.
- To assess the subclinical disease activity in early-stage MS.
- To evaluate the potential of MR imaging in monitoring MS activity and treatment efficacy.
Main Methods:
- Prospective study design.
- Serial brain MR scans conducted every 2 weeks for 4 to 6 months.
- Inclusion of 9 patients with mild, clinically definite, relapsing-remitting multiple sclerosis.
Main Results:
- Twelve new asymptomatic lesions were detected in 6 out of 9 patients.
- New lesions exhibited a temporal profile: maximum size at ~4 weeks, followed by gradual shrinkage.
- No new neurological symptoms or signs correlated with the appearance of new MR lesions.
- Residual abnormalities after lesion shrinkage were indistinguishable from chronic MS lesions.
Conclusions:
- Multiple sclerosis exhibits significant subclinical disease activity even in mildly affected patients.
- Serial MR scanning is a valuable tool for detecting and quantifying MS disease activity, especially in asymptomatic individuals.
- The expanding and contracting lesions observed may represent the primary pathological process in MS, with chronic plaques being the residual outcome.