Here is My Question:
Is it protocol to change a patient's medication based on new symptoms without ordering a new MRI?
It is certainly appropriate to change DMTs without a repeat MRI, if there are meaningful alterations in symptoms, usually accompanied by changes on examination, that indicate significant disease activity. It is my opinion that a repeat MRI scan should be obtained in all relapsing remitting MS people with MS at least 3 months after starting the new treatment to establish a new baseline for monitoring the response to the new treatment. Repeat MRI scans are less useful in people with primary or secondary progressive MS unless there is a specific reason to be concerned that you may have recurrent or new inflammatory disease activity or another condition affecting the nervous system.
The timing of repeat MRI scans is the subject of much debate and variance around the united states and elsewhere. I would recommend that you discuss your physician's reason for his or her decision.
Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego
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