Using MRI scans can help neurologists make the diagnosis of multiple sclerosis (MS) more quickly, according to a guideline developed by the American Academy of Neurology. The point at which MS can be diagnosed has been under debate, according to guideline author Elliot Frohman, MD, PhD. “Before, the criteria used to diagnose people required neurologists to show that disease activity had occurred in the brain over time,” said Dr. Frohman. “People would have to wait for 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.”

SEEKING GUIDANCE

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. To develop the guideline, the researchers evaluated all of the scientific studies on the topic. They determined that in many cases evidence of white matter abnormalities detected in different regions of the brain on a sophisticated MRI scan, when considered in concert with clinical indications of the disease, may effectively replace diagnostic methods that have typically required months or even years of clinical observation. “This assessment provides compelling evidence that in the majority of patients with a first MS-like attack, the presence of characteristic MRI lesions within the central nervous system strongly predicts future conversion to clinically definite MS,” reported Dr. Frohman.

A TELESCOPE INTO THE FUTURE

The guideline, which was published in the September 9 Neurology, “helps us use MRI to telescope into the future to see what’s going to happen with these patients,” Dr. Frohman said. He is an Associate Professor of Neurology and Ophthalmology and Director of the Multiple Sclerosis Program at the University of Texas Southwestern Medical Center in Dallas. “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,” he added.

Evidence has shown that early treatment of MS can lessen the disease activity and severity. There is also evidence that if the disease remains untreated in the early stages, it can accelerate. The disease may even become resistant to treatment, Dr. Frohman noted. “With this knowledge and the fact that the current drugs for MS have few downsides except for cost and minor side effects, there’s not much sense in waiting for more disability and more attacks to occur,” he said.

MORE SENSITIVE CRITERIA

The criteria currently used for diagnosis are not sensitive enough to identify many patients who already have MS at the time of their first attack, according to Dr. Frohman. The current criteria recommend waiting for additional signs of disease activity before making the diagnosis of MS.

“In some ways, that’s like waiting for the other shoe to drop,” he remarked. “If the majority of these patients have MS and waiting could compromise how we can affect the course of the disease, then we need to go ahead and treat them.”

With the new method, diagnosis can be confirmed as early as a patient’s first clinical attack, said Dr. Frohman. For patients, this simpler method could mean quicker access to therapies that can help keep disease symptoms at bay for many years.

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Suggested Reading
Frohman EM, Goodin DS, Calabresi PA, et al. The utility of MRI in suspected MS: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2003;61:602-611.

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