Spinal Cord Lesions & The Risk of Relapse

Research Summary: Relevance of asymptomatic spinal MRI lesions in patients with multiple sclerosis

The background

Magnetic resonance imaging or MRI has become a common tool for the diagnosis of multiple sclerosis (MS).  Recent expert opinion has also recommended that people with MS should have an MRI performed on an annual basis to monitor the disease.  However, with the FDA currently investigating potential side-effects of the MRI contrast agent gadolinium, it becomes necessary to question the benefits of the regular use of this technique.

Previous studies have shown that brain lesions that do not cause symptoms, known as asymptomatic brain lesions, can be useful in the prediction of the risk of experiencing relapses.  For this reason, it is often used as a measure of treatment effectiveness in MS therapy trials.  However, many studies have shown either no connection or only a very weak connection to the presence of these lesions and disease progression.

It is also known that 90% of people with MS will develop lesions on their spine.  These lesions often present with symptoms, but asymptomatic spinal lesions also occur.  However, very little is known about the predictive value of asymptomatic spinal cord lesions.

The study

In this study by researchers at the Neurocenter of Southern Switzerland, the predictive value of asymptomatic spinal cord lesions was assessed.  This was performed by analysing data that had been collected in the MS registry at the hospital.  To be included in the study, patients had to meet the following criteria:

• Be diagnosed with relapsing-remitting MS
• Had baseline brain and spinal MRIs
• Had a second spinal MRI within 1-3 years after the original MRI, as well as a second brain MRI within 30 days of the second spinal MRI
• Be clinically stable in between the time points
• Have data for at least an extra two years after the second set of MRI images

After screening, 104 patients were included in the study.

The findings

The study showed that at the second MRI time point, 25% of people had developed new asymptomatic spinal lesions.  As well as this, 44% had developed new asymptomatic brain lesions.  In both circumstances, there were cases were one occurred without the presence of the other (i.e. new spinal lesions without new brain lesions and vice versa).

In between the second and third time point, 31 people had a total of 67 relapses.  The presence of asymptomatic lesions in the people that had relapses was compared to those that were relapse-free.  It was found that there was a significantly higher risk of having a relapse if you had developed a new asymptomatic spine or brain lesion than if you had developed neither.  Similar to previous studies, the data showed no significant link between the presence of asymptomatic lesions and disability progression.

The outcomes

This study has shown that in addition to using MRI to detect new asymptomatic brain lesions, imaging the spine for asymptomatic spinal lesions is also beneficial to predict the risk of an individual undergoing a relapse.  This additional information could be useful in determining the response to specific treatments in people with MS.  However, this study also provides further evidence that the presence of these lesions does not appear to coincide with disease progression.

Learn more

The abstract for this article can be viewed here.