If my MS is inactive how often do I need to have an MRI? I am claustrophobic and so MRIs are not fun and my doctor says I need one every 5 months? I haven't had any new symptoms so why do I need MRIs so often?
This is a great question. How often a person needs to obtain a repeat MRI really depends on the circumstances. Let’s take the easy extremes to start:
- A person stable by clinical and MRI criteria (no relapses, worsening symptoms or new MRI lesions) after 3 years of Disease modifying therapy probably does not need an MRI more often than every 2 years or when something new happens
- A person with MS for more than 10 years with secondary progressive disease and no relapses in over 2 years probably does not benefit from repeat MRIs at all unless their rate of worsening is very rapid
This leaves everyone in between. Current recommendations are to repeat MRIs of the brain only every year unless there is a specific reason to do them sooner; the exceptions include monitoring people with more active disease, monitoring patients in the first year of treatment with a disease modifying therapy and monitoring for the development of PML in high risk patients on Tysabri. Most asymptomatic MS disease activity is reflected by an MRI of the brain so the spinal cord is less important in most circumstances for monitoring.
Of course, it is only useful to repeat MRIs to monitor MS if it is done correctly. Sadly this is usually not the case in most clinical setting. For this reason, MRIs tend to be most useful in the first 5 years after a diagnosis, when it is relatively easier to determine if there is anything new.
In the near future we will be rolling out a way for people to ensure that useful information is obtained on repeat MRIs. Stay tuned to this site to learn more.
As for claustrophobia, I hear you loud and clear. For diagnostic purposes an open MRI will usually suffice but for repeat image analysis closed systems are preferable. Most people do very well with a good dose of lorazepam (1.5 to 2.0 mg) or alprazolam (same dose) about an hour before an MRI. You will need someone to drive you home
Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego