Is MS ever considered dormant or benign ? If so, is it safe to stop MS medications?
This is one of the best questions I’ve been asked in a long time. We can theoretically define a state of total remission from MS, but it would be difficult to prove in a typical clinical setting without improved technologies and practices. This state of remission would probably include the following features:
1. There would certainly be no further relapses, but this is probably a minor point since relapses become rare even in untreated patients as they get older
2. There would be no new or enlarging white matter lesions or gray matter lesions. This can be difficult to define accurately with the type of MRI scans obtained in clinical practice but this could be accurately accomplished with newer image sequences and quantitative image analysis
3. There would be no progression of disability over time in excess of what is expected in the context of normal aging occurring in the context of a previously damaged nervous system from MS
4. The rate of both regional and global brain atrophy should be no more than age and sex matched healthy controls
5. Better biomarkers of both inflammatory or degenerative disease activity would also help define this state of remission but these are not available yet
I have always felt that patients with few risk factors for disease activity or progression at onset who remain stable by MRI or clinical criteria for 10 years on older partially effective injectable therapies, can probably discontinue these therapies at that time. Specifically, if a patient with a single attack, a small number of white matter lesions and no brain atrophy completely recovers and remains without relapse, progression, new MRI lesions or change in atrophy over 10 years on a partially effective therapy, they probably would have been stable even without the therapy.
Revere Kinkel MD
Director of the UCSD Multiple Sclerosis Program