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Multiple Sclerosis (MS)
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The Course of MS
Each case of Multiple Sclerosis (MS) displays one of several patterns of presentation and subsequent course. Most commonly, MS first manifests itself as a series of attacks followed by complete or partial remissions as symptoms mysteriously lessen, only to return later after a period of stability. This is called relapsing-remitting (RR) MS. Primary-progressive (PP) MS is characterized by a gradual clinical decline with no distinct remissions, although there may be temporary plateaus or minor relief from symptoms. Secondary-progressive (SP) MS begins with a relapsing-remitting course followed by a later primary-progressive course. Rarely, patients may have a progressive-relapsing (PR) course in which the disease takes a progressive path punctuated by acute attacks. PP, SP, and PR are sometimes lumped together and called chronic (lasting a long time) progressive MS.
In addition, twenty percent of the MS population has a benign form of the disease in which symptoms show little or no progression after the initial attack - these patients remain fully functional. A few patients experience malignant MS, defined as a swift and relentless decline resulting in significant disability or even death shortly after disease onset. However, MS is very rarely fatal and most people with MS have a fairly normal life expectancy.
Studies throughout the world are causing investigators to redefine the natural course of the disease. These studies use a technique called * Magnetic Resonance Imaging (MRI) to visualize the evolution of MS lesions in the * white matter of the brain. Bright spots on a T2 MRI scan indicate the presence of lesions, but do not provide information about when they developed.
Because investigators speculate that the breakdown of the * blood/brain barrier is the first step in the development of MS lesions, it is important to distinguish new lesions from old. To do this, physicians give patients injections of * gadolinium, a chemical contrast agent that normally does not cross the blood/brain barrier, before performing a scan. On this type of scan, called T1, the appearance of bright areas indicates periods of recent disease activity (when gadolinium is able to cross the barrier). The ability to estimate the age of lesions through MRI has allowed investigators to show that, in some patients, lesions occur frequently throughout the course of the disease even when no symptoms are present.
Definitions For This Page - In Alphabetical Order
* Blood/Brain Barrier
Blood/Brain Barrier is a membrane that controls the passage of substances from the blood into the central nervous system.
* Gadolinium
Gadolinium is a chemical compound given during Magnetic Resonance Imaging (MRI) scans that helps distinguish new lesions from old.
* Magnetic Resonance Imaging (MRI)
Pronounced - mag-NEH-tik REH-zuh-nunts IH-muh-jing
Magnetic Resonance Imaging (MRI) is a * non-invasive scanning technique that enables investigators to see and track Multiple Sclerosis (MS) lesions as they evolve. MRI is a procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or x-ray. MRI imaging is especially useful for imaging the brain, the spine, the soft tissue of joints, and the inside of bones. Also called nuclear magnetic resonance imaging or NMRI.
* Non-Invasive
Pronounced - NON-in-VAY-siv
In medicine, for example, non-invasive describes a procedure that does not require inserting an instrument through the skin or into a body opening. In cancer, non-invasive describes disease that has not spread outside the tissue in which it began.
* White Matter
Nerve fibers that are the site of multiple sclerosis (MS) lesions and underlie the gray matter of the brain and spinal cord.
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References:
NIH Publication No. 96-75
September 1996
www.ninds.nih.gov
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