EMBARGOED FOR RELEASE UNTIL 4 PM ET, September 08, 2003
Guideline: MRIs Help Diagnose Multiple Sclerosis Faster
ST. PAUL – Using MRI scans can help make the diagnosis of multiple sclerosis (MS) more quickly, according to a guideline developed by the American Academy of Neurology. The guideline is published in the September 9 issue of Neurology, the scientific journal of the American Academy of Neurology. The point at which MS can be diagnosed has been under debate, according to one of the guideline authors Elliot Frohman, MD, PhD, of the University of Texas Southwestern Medical School in Dallas. “Before, the criteria used to diagnosis people required neurologists to show that disease activity had occurred in the brain over time,” said Frohman. “People would have to wait and experience one or more attacks before a diagnosis. Now that we have evidence showing that early treatment can reduce the entire course of the disease, we really needed to ask the question about how early the diagnosis can be made.” To develop the guideline, the researchers evaluated all of the scientific studies on the topic. They determined that in many cases findings on a single MRI of the brain and spinal cord can be a strong indicator of whether someone will develop MS in the future. The guideline addresses cases where a young to middle-aged adult has a single occurrence of a sign or symptom of MS activity and other possible diagnoses have been ruled out. MS involves inflammation of the brain and spinal cord. This inflammation leads to lesions, or areas of damage, on the brain and spinal cord. The guidelines outline the number and type of these lesions that, if present, are a strong predictor of the future development of clinically definite MS. For example, a patient with three or more lesions in the white matter area of the brain has a greater than 80-percent likelihood of developing MS within the next seven to 10 years. What still cannot be determined is the course of the disease, which can vary from mild to severe. Frohman said. “The evidence allows us to predict with more certainty who will develop MS, which allows us to begin helpful treatment earlier than in the past.” Evidence shows that early treatment of MS can lessen disease activity and severity. There is also evidence that, if untreated in the early stages, the disease can accelerate and may even become resistant to treatment, Frohman said. Since current treatments can alter the course of disease, identifying individuals with a high likelihood of having significant future disabilities early in their illness is important. While identifying such individuals with certainty is not possible, neurologists trained in MS can use the new MRI guidelines to help in this assessment. “With this knowledge and the fact that the current drugs for MS are relatively well tolerated, there’s not much sense in waiting for more disability and more attacks to occur,” Dr. Frohman said. The diagnosis of MS remains a clinical one and MRI changes alone are not sufficient to say a person has MS. Indeed, the guideline notes that neurologists must consider MRI information in the context of each patient’s specific situation. However, criteria currently used for diagnosis are not sensitive enough to identify many patients who already have many of the changes of MS at the time of their first attack, Frohman said. The current criteria recommend waiting for additional signs of disease activity before making the diagnosis of MS. These additional signs of disease activity can consist of changes on MRI and do not require additional attacks. Patients with early and potentially disabling MS can be identified, waiting could compromise the effectiveness of our current treatments and such persons should be treated as soon as feasible.
The American Academy of Neurology is the world's largest association of neurologists and neuroscience professionals, with 32,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer's disease, stroke, migraine, multiple sclerosis, concussion, Parkinson's disease and epilepsy.
Editor's Notes:The guideline, clinician summary, patient summary and supplemental data are available at http://www.aan.com/professionals/practice/guideline/index.cfm.