Latest find in research on value of MRI in predicting course of ms ...            10/09/20.

Patterns of disease activity in multiple sclerosis: clinical and magnetic resonance imaging study.

BMJ. 1990 Mar 10;300(6725):631-4.
Thompson AJ, Kermode AG, MacManus DG, Kendall BE, Kingsley DP, Moseley IF, McDonald WI.
Multiple Sclerosis NMR Research Group, Institute of Neurology, London.

Abstract
OBJECTIVE: To compare the abnormalities shown by magnetic resonance imaging of the brain in three clinically distinct groups of patients with multiple sclerosis, and to correlate the extent of abnormality with the degree of clinical disability in the three groups.
DESIGN: All patients underwent magnetic resonance imaging and full neurological examination, and their disability was scored according to the expanded Kurtzke disability state scale.
SETTING: National Hospital for Nervous Diseases (Multiple Sclerosis NMR Research Group).
PATIENTS: Three groups of patients with confirmed multiple sclerosis were studied: 12 patients with minimal disability despite a long (greater than 10 years) duration of illness (benign multiple sclerosis), 16 who had developed progressive disability after a relapsing and remitting course (secondary progressive multiple sclerosis), and 13 who had had progressive disability from the onset of the disease (primary progressive multiple sclerosis).
MAIN OUTCOME MEASURES: Number and size of lesions in 17 anatomically defined sites; total lesion load, estimated with an arbitrary scoring system weighted for the size of lesions; and disability score.

RESULTS: Magnetic resonance imaging showed that all 41 patients had abnormalities. These were extensive in the groups with secondary progressive and benign disease compared with the group with primary progressive disease. The lesions in the patients with secondary progressive disease were larger and more confluent than those in the two other groups (p = 0.007). Most lesions (85%) in the patients with primary progressive disease were under 5 mm in diameter; this percentage was higher than that in the two other groups (p = 0.032). Consequently the patients with primary progressive disease had the lowest mean lesion load (36.7); that in the patients with benign disease was 52.7 and that in the patients with secondary progressive disease 64.6 (p = 0.05). No correlation existed between disability and total lesion load. The distribution of brain lesions and of detectable lesions of the spinal cord, and the frequency of cortical atrophy, were similar in all groups.

CONCLUSIONS: No relation was found between the degree of clinical disability and the extent of abnormality shown by magnetic resonance imaging: patients with clinically benign disease often had extensive abnormalities and those with primary progressive disease had surprisingly few lesions. Though magnetic resonance imaging increases knowledge of the disease process in multiple sclerosis and is invaluable in diagnosis, it is not helpful in predicting disability in individual patients.

and another update ...

This recent email from Lynne McTaggart's website is worth checking out, and you can sign up for regular email updates ... author of The FIELD THE QUEST FOR 

THE SECRET FORCE OF THE UNIVERSE  8 2001  Quill, An Imprint of HarperCollinsPublishers Inc, New York. 

Subject: WDDTY e-News Broadcast - 27 April 2006 (Lynne McTaggart) 
WHAT DOCTORS DON'T TELL YOU READERS' BROADCAST  -  E-news broadcast. 252 - 27 April 2006 

MS:  Hospital scans usually get it wrong 
How do you know if you've got the beginnings of multiple sclerosis?  Your suspicions may be raised if you suffer two separate - and different - neurological malfunctions, and this is the acid test before deciding to see the doctor. 
If this happens to you, your doctor will arrange for you to have a hospital examination, which will be an MRI (magnetic resonance imaging) scan.  This is the standard treatment for determining MS cases, as it can detect 'clinically silent' lesions in the brain. 
Unfortunately, the scan is a hopelessly inaccurate method of detection, and researchers have also discovered that lesions - even lots of them in the brain - don't necessarily indicate the presence of MS. 
This striking piece of new research suggests that medicine doesn't have any reliable tools at its disposable to detect MS. Worse, it means that many cases of MS aren't MS at all, and patients and their families go through years of hell when there isn't much wrong with the person. 
The MRC Health Services Research Collaboration in Bristol reviewed 29 studies on MRI and MS, and discovered that the scan could not rule out -or rule in, come to that - the possibility of MS.  The presence of brain lesions didn't indicate MS either.  Even patients with 10 or more brain lesions didn't develop MS, the study found. 
(Source: British Medical Journal, 2006; 332: 875-8).

Abstract follows ...

Accuracy of magnetic resonance imaging for the diagnosis of multiple sclerosis: systemic review, British Medical Journal, 2006; 332: 875-8. Penny Whiting, Roger Harbord, Caroline Main, Jonathan J Deeks, Graziella Filippini, Mathias Egger and Jonathan AC Sterne.  
[assumption that any dark spot on MRI is actually a lesion related to disease process ...em] ... with about a 36% accuracy, magnetic resonance imaging is of limited utility in ruling out the diagnosis of multiple sclerosis ... not all patients who experience a first attack will develop the disease and currently no treatment has been shown to delay conversion to clinically definite multiple sclerosis or impact on long term disability. ... High quality clinical research based on improved magnetic resonance imaging techniques and measures in combination with a complete description of participants and long term clinical follow-up are needled for qualitative assessment of the clinical efficacy of magnetic resonance imaging in the diagnosis of multiple sclerosis. The disease remains a  predominantly clinical diagnosis. 

Discrepancies in the interpretation of clinical symptoms and signs in the diagnosis of multiple sclerosis. A proposal for standardization. Mult Scler. 2005 Apr;11(2):227-31. Uitdehaag BM, Kappos L, Bauer L, Freedman MS, Miller D, Sandbrink R, Polman CH.
Department of Neurology, VU University Medical Centre, Amsterdam, The Netherlands. bmj.uitdehaag@vumc.nl
The new McDonald diagnostic criteria for multiple sclerosis (MS) incorporate detailed criteria for the interpretation and classification of magnetic resonance imaging (MRI) findings, but, in contrast, provide no instructions for the interpretation of clinical findings(of MRIs) . Because MS according to the McDonald criteria is one of the primary endpoints in a large trial enrolling patients after the first manifestation suggestive for a demyelinating disease (BENEFIT study), it was decided to organize a centralized eligibility assessment for this trial. During this eligibility assessment it was observed that there were marked inconsistencies in the decisions of participating neurologists with respect to the classification of clinical symptoms as being caused by one or more lesions provoking discussions in about one in every five patients. This paper describes these inconsistencies and their sources, and recommends a systematic approach that attempts to reduce the variability in interpreting clinical findings.

Beck RW, Trobe JD, Moke PS, Gal RL, Xing D, Bhanti MI et al, High- and low-risk profiles for the development of multiple sclerosis within 10 years after experience of the optic neuritis treatment trial, Arch Opthalmol 2003, 121:944-9. 

Brex PA, Ciccarelli O, O'Riordan JI, Sailer M, Thompson AJ, Miller DH, A longitudinal study of abnormalities on MRI and disability from multiple sclerosis, New England Journal Medicine 2002, 346:158-64. 

Recent papers by Romberg(2004), LeBolt (2004) and Patti (2003), observe that lack of movement and toxic drug side effects are far more damaging than the disease process. Negative drug side effects are ignored or explained away as more symptoms.