Welcome to the Virtual MS Center!
Ask any question you want about Multiple Sclerosis and one of our experts will answer it as soon as possible.
Here is My Question:
Do I really need another MRI? Over past three years I have been followed by specialist and symptoms have been minimal: tingling, heat insensitivity and chronic fatigue for which I take mess. During this time I was also dx'd with optic atrophy from optic neuritis but again symptoms were subacute. I have had 3 Brain mris. First showed 4 nonspecific white matter changes, with second some had disappeared and with third I was told it was possible to count 8, still nonspecific but radiologist still reports as normal MRI. So now I have to have a 4th a year later. Is it worth it? I mean from point of view of expense as well as exposure to contrast- I have also had spine mris which showed nothing. Is there a real chance I could have MS or am I being followed from an excess of caution? Is another MRI the way to go or would you suggest other testing or nothing? I would really welcome your advice as I am feeling very unsure. Answer: I can understand why you are perplexed. For instance, I would never tell a person with MS that they have “8 lesions” and then turn around and say their MRI is normal. It is possible for an MRI to display innumerable non-specific white matter hyperintensities but this would not be supportive of a diagnosis of MS. The ultimate question is why are your physicians obtaining MRI scans on a regular basis. It sounds as if they are not at all certain of the diagnosis. If this is the case, spinal fluid analysis is quite useful. This is done with a procedure called a lumbar puncture or “spinal tap.” If it is felt that your MRI has not shown any significant changes over 3 years (this is a big if), there is little reason to repeat MRIs frequently. My practice is to obtain monitoring MRIs at 6, 18 and 36 months then 5 and 10 years in people with symptoms and findings consistent with MS (such as your residual optic atrophy) but minimal evidence to support an active diagnosis. Clinical re-evaluations are done on a yearly basis and we move up an MRI scan if we believe the disease has become clinically active. I would never treat an individual without stronger evidence to support a diagnosis of MS. Revere (Rip) Kinkel MD Director of the Multiple Sclerosis Program Professor of Clinical Neurosciences University of California San Diego Here is My Question:
My daughter was diagnosed 17 months ago at 13 years old. She has done steroids, IvIG and she is on Tysabri. Every MRI shows new lesions (she has had too many to count since her first MRI). Her neuro is thinking she might have progressive not relapsing. My question is what do they use to slow down the progression? Is PPMS terminal? Answer: While we cannot offer specific recommendations or diagnoses, there are several things to consider. First, some kids need aggressive therapy to get their MS under control and new lesions on MRI does not mean a child has progressive MS – it usually means they have more active relapsing remitting MS. It is important to work with your clinician to determine if the tysabri is working. A new baseline MRI after four infusions would be the scan to compare subsequent MRIs to. If there were new lesions AFTER that baseline scan, then there should be a discussion about potentially switching therapy. Benjamin M. Greenberg, MD, MHS Director, Transverse Myelitis, Neuromyelitis Optica Programs Director, Neurosciences Clinical Research Center Co-Director, Pediatric CONQUER Program UT Southwestern Medical Center Childrens Health Dallas, Texas Tel 214-645-0555 |
PLEASE NOTE: This information/opinions on this site should be used as an information source only. This information does not create any patient-HCP relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.
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