MRI Scans Could Predict Multiple Sclerosis (MS) Disability

New research published in Brain states that early MRI scans of people living with multiple sclerosis (MS) could predict how their condition will progress, including how disabled they are likely to become.

The MS Society funded study followed 164 people with clinically isolated syndrome* (CIS) over a 15 year period. Monitoring how MS developed, researchers discovered that MRI scans from when individuals were first diagnosed contained signs of future progression. For example, early spinal cord damage indicated people were much more likely to go on to develop the secondary progressive form of MS, which currently has no treatment and is where disability gets steadily worse. A spinal cord MRI indicated the level of disability a person was likely to face in future.

They also found an association between lesions seen in the brain at the time of CIS, and a person’s physical and cognitive performance later in life.

Over 100,000 people live with MS in the UK, and one of the most difficult things about being diagnosed is the uncertainty of the condition. The course MS takes is highly variable with significant differences in terms of how quickly it progresses, how disabled a person may become, and how cognitive performance is affected.

Director of Research at the MS Society, Dr Susan Kohlhaas, 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 currently 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. We’re pleased to have funded the work and look forward to seeing it progress so people living with MS can finally have more certainty about the future.”

Melanie Ellis, 53, from Walthamstow in London, has relapsing MS and participated in the research. She said: “I signed up to the study over 15 years ago – at the time I didn’t even know I had MS, but I’d lost my vision in one eye and they asked me to take part. My view is if you can help and it isn’t going to cause you any pain, go for it. I’m amazed by the results today. 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! 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.”

After 15 years, all participants were followed-up with, and their disability was assessed using measures including the Expanded Disability Status Scale (EDSS). 94 (57%) had the relapsing form of multiple sclerosis, 25 (15%) had the secondary progressive form, 45 (27%) remained CIS and two people (1%) had developed other disorders.

As well as knowing how a person’s condition might progress – and being able to plan for their future accordingly – this information will help healthcare professionals personalize treatment plans, which is particularly important for patients identified as high-risk for disease progression. A recent study suggested early intensive treatment leads to a better MS prognosis – but without information about how a person’s disease is likely to progress it can be challenging to make such a decision.

The study was led by Dr Wallace Brownlee and MS Society Scientific Ambassador Professor Olga Ciccarelli. Dr Brownlee said: “We already use MRI scans to diagnose MS and to monitor the course of the disease. These findings – which suggest existing measures, routinely available in clinical practice, can provide a long-term prognosis – are 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 might progress will mean more certainty, better treatment choices, and hopefully better long term outcomes for everyone living with the condition.”

* People with CIS have experienced one episode of neurological symptoms and often go on to be diagnosed with MS.

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