MRI scans could help doctors predict how a multiple sclerosis (MS) patient’s disease will progress, research suggests.
University College London scientists followed 160 people who had clinically isolated syndrome (CIS) for 15 years.
The condition causes MS-like symptoms, such as muscle weakness. Patients often go on to be diagnosed with the full-blown disorder.
The patients underwent MRI scans, which are routinely available in clinical practice, shortly after their CIS diagnosis.
These picked up lesions in their brains and spinal cords, which was found to raise their risk of developing MS by more than four times.
The researchers claim it is ‘a major advance’ which could lead to better treatment choices and long-term outcomes for patients.
MRI scans could help doctors predict how a MS patient’s disease will progress (stock)
‘We already use MRI scans to diagnose MS and to monitor the course of the disease,’ lead author Dr Wallace Brownlee said.
‘These findings suggest existing measures, routinely available in clinical practice, can provide a long-term prognosis.’
Dr Brownlee added: ‘[This is] a major advance that will be welcomed by many in the MS community. MS can be relentless, painful and disabling.
‘But being able to predict how a person’s MS may progress will mean more certainty, better treatment choices and hopefully better long-term outcomes.’
MS affects 2.3 million people worldwide, including around 400,000 in the US and 100,000 in the UK, statistics show.
It is currently incurable, with treatments mainly focusing on treating symptoms and reducing relapses.
MS’ severity is hard to predict, with patients varying in their disease progression, degree of disability and cognitive impairment.
There is therefore a need for ‘robust markers’ that allow doctors to gauge the best treatments for patients, the researchers said.
Guidelines recommend spinal MRI scans in CIS sufferers to assess their risk of additional ‘attacks’.
However, these are not routinely carried out due to the scans’ apparent ‘modest’ benefits in diagnosing patients, the researchers wrote.
Little is also known about the scans’ ability to predict a CIS patient’s risk of disability in the future.
To learn more, the researchers analysed 164 CIS patients within three months of them being diagnosed.
WHAT IS MULTIPLE SCLEROSIS?
Multiple sclerosis (known as MS) is a condition in which the immune system attacks the body and causes nerve damage to the brain and spinal cord.
It is an incurable, lifelong condition. Symptoms can be mild in some, and in others more extreme causing severe disability.
MS affects 2.3 million people worldwide – including around 400,000 in the US, and 100,000 in the UK.
It is more than twice as common in women as it is in men. A person is usually diagnosed in their 20s and 30s.
The condition is more commonly diagnosed in people of European ancestry.
The cause isn’t clear. There may be genes associated with it, but it is not directly hereditary. Smoking and low vitamin D levels are also linked to MS.
Symptoms include fatigue, difficulty walking, vision problems, bladder problems, numbness or tingling, muscle stiffness and spasms, problems with balance and co-ordination, and problems with thinking, learning and planning.
The majority of sufferers will have episodes of symptoms which go away and come back, while some have ones which get gradually worse over time.
Symptoms can be managed with medication and therapy.
The condition shortens the average life expectancy by around five to 10 years.
The patients underwent brains and spinal cords scans, which were repeated several years later.
Fifteen years on, the patients’ disease progression and physical disability was assessed.
Some 119 went on to get relapsed-remitting MS (RRMS) – when symptoms appear for months or even just hours before fading.
And 25 had secondary progressive MS. This is the next stage after RRMS and occurs when a patient’s disability gradually gets worse.
Results published in the journal Brain revealed all the 58 patients with an abnormal spinal cord scan developed MS.
This is compared with the 62 (58 per cent) MS sufferers who had a normal scan, the study also revealed.
And 111 (89 per cent) of those with an abnormal brain scan developed MS, compared to eight (21 per cent) of those with a normal MRI.
Tissue damage in the brain and spinal cord was also associated with a worse score on the Expanded Disability Status Scale years later.
‘Our findings suggest spinal cord MRI has significant prognostic value in CIS patients, and may be useful in identifying those at high-risk of later disease progression and physical disability,’ the researchers wrote.
The scans could also be used to ‘monitor the course of MS’, which could help doctors personalise treatment plans for their patients, they added.
Dr Susan Kohlhaas, director of research at the MS Society, which funded the study, said: ‘MS damages nerves in your body and makes it harder to do everyday things like walk, talk, eat and think.
‘It’s also different for everyone and there isn’t a consistent way of predicting what course MS might take.
‘This can be incredibly distressing and make decisions about treatment, family, and life in general very difficult.
‘By identifying key factors that appear very early on and indicate how someone’s MS might develop, this study has proved crucial.’
The researchers accept, however, carrying out these scans will increase costs.
MS PATIENT, 53, REVEALS SHE CAN ‘LIVE HER LIFE’ AFTER TAKING PART IN THE TRIAL HELPED HER ‘PLAN FOR THE FUTURE’
Melanie Ellis (pictured) has revealed how taking part in the research has helped her ‘plan for the future’ and ‘live her life’
An MS patient has revealed how taking part in the research has helped her ‘plan for the future’ and ‘live her life’.
Melanie Ellis, 53, of London, signed up for the study more than 15 years ago.
At the time, she had lost vision in one of her eyes but did not know what was wrong.
Ms Ellis, who has since been diagnosed with relapsing MS, was invited to take part in the trial.
‘I know not everyone will want to know how their MS is going to turn out but it’s different for everyone and I’m the sort of person who likes to know,’ she said.
‘If you know what’s going on you can at least deal with it, rather than sitting waiting for something awful to happen.
‘If someone can tell you “well this is the likely impact”, it means you can live your life and plan for the future.’