Why isn't my neurologist sending me for a spinal scan?

Here is My Question:
I was diagnosed 6 months ago.

I have been on Tecfidera and I am due my 6 month scan this week. My neurologist is sending me for a brain scan, but no spinal scan.  I am a bit confused that I am not having a spinal scan as when I was diagnosed I had 3 lesions on the spine but none on the brain. I also would like to know how do you really know if the Tecfidera is working, I could have more on the spine and still none on the brain?

Answer:
There is general agreement that more frequent monitoring MRI scans need only include the brain for 4 reasons:

1. New activity (New or enlarging T2 lesions or white spots) is far more common in the brain, especially new activity not producing any evident symptoms, which is the whole reason for MRI monitoring

2. When new activity involves the spinal cord it also involves the brain in well over 80 % of cases; new activity in the spinal cord is also more commonly symptomatic.

3. Community acquired MRI scans (non research scans) are inadequate for monitoring the spinal cord in most cases and provide very little additional information. In your case, monitoring the brain for new activity is easy since there was little evidence of MS (by your description the brain was “normal”) on the original MRI and anything observed on the next scan would be considered new.

4. Monitoring both the brain and spinal cord is prohibitively expensive and rarely alters treatment decisions. 

Remember we are not just using the repeat MRI scan for treatment decisions. We are also using your symptoms, examination findings and functional status for these decisions. If you were to exhibit new symptoms and findings related to involvement of the spinal cord, your physician would use this information to consider adjusting your treatment even if the MRI of the head revealed no new activity.

Revere (Rip) Kinkel MD
Director of the Multiple Sclerosis Program
Professor of Clinical Neurosciences
University of California San Diego