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Issue: Issue 3 (2016) – Supplement 1


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My MRI worsened but I didn't. Should I change my disease-modifying treatment?

Author(s):
Uros Rot
Abstract:
It is imperative to recognize multiple sclerosis (MS) patients with high risk of disability progression as soon as possible and offer them more potent treatment. Data about the influence of early conventional MRI parameter worsening (without clinical progression or relapses) on early or late disability in treated MS patients are available mainly for interferons beta. Some of the studies showed that the development of new T2 or Gd enhancing lesions in the first year of interferon beta treatment predicted second and third year disease activity or worse late clinical outcome, but some of the studies were negative. The first-year MRI activity was not associated with clinical worsening of the disease in the next two years in patients treated with glatiramer acetate. There are no data which would indicate that the MRI-only worsening in patients treated with the oral drugs or monoclonal antibodies predicts poor outcome. There are many caveats which also need to be taken into account when considering an individual patient with the MRI-only worsening for escalation of therapy such as adherence to the injectables, presence of neutralizing antibodies, large interrater variability for comparative MRI data and adverse effects of the second-line drugs. Therefore a close clinical and MRI follow-up of patients with the MRI-only worsening is appropriate but escalation should be given only to those with more realistic risk of a poor prognosis. 

Keywords: Multiple sclerosis, Treatment, Prognosis, MRI

Special Issue on Controversies in Neurology. From the 10th World Congress on Controversies in Neurology (CONy), Lisbon, Portugal. 17–20 March 2016.

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 1):S08 
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