MS Wrap-up: Measuring Disease Activity in MS, MRI Guidelines Updated, and More

Biomarker Shows Promise in MS

As reported by NeurologyLive®, neurofilament light chain (NfL) may prove to be a more reliable marker for disease progression and treatment indication in multiple sclerosis (MS) than MRI. The serum biomarker facilitates easier and earlier assessment of neurodegeneration.

Noting that results seen with MRI can vary and that clinical trial settings testing its effectiveness “are a far cry from real life,” author Mark Freedman, MD, MSc, HBSc, CSPQ, FANA, FAAN, FRCPC, highlights how consistent high levels of NfL in blood serum can indicate accumulated damage. This is despite the biomarker being measured at an approximate level of 1/500 compared with its measurement in cerebrospinal fluid, where it is first released.

NfL has shown remarkable promise in MS compared with other neurological diseases (eg, Parkinson disease, motor neuron disease) due to the lack of confounding comorbid conditions in the typically younger patient population, Freedman notes.

Read the entire article here.

Consensus Recommendations for MRI in MS Released

The Magnetic Resonance Imaging in Multiple Sclerosis study group, the Consortium of Multiple Sclerosis Centers working group, and the North America Imaging in Multiple Sclerosis MRI Guidelines working group—comprising experts from North America and Europe—have come together to issue consensus recommendations for the use of MRI in persons with MS.

NeurologyLive® reports that a principal focus of the new guidelines is implementing standardized MRI protocols for diagnostic and prognostic purposes. Specifically, 3D acquisition techniques are emphasized because of their ability to detect lesions and because they can “contribute to better realignment of anatomic orientation on serial scans.”

What is not recommended are 7T scanners for diagnosing and monitoring MS. Instead, experts note, 1.5T scanners are sufficient. In addition, when imaging, the groups’ recommendations include getting 2 of these 3 sagittal sequences: T2-weighted spin echo with moderately long echo times, proton density-weighted echo, or short tau inversion recovery.

Read the entire article here.

Experts Discuss Optimal Treatment Strategies for RRMS

In a recent NeurologyLive® Peer Exchange moderated by Scott D. Newsome, DO, MSCS, FAAN; Patricia K Coyle, MD; and Robert Fox, MD, debated the best approaches to addressing relapsing-remitting MS (RRMS).

Noting a desire to optimize treatment with disease-modifying therapies, Coyle stated that patients are closely monitored and communication with them should be constant. She also stated that having 1 new lesion is insufficient as a measure of disease breakthrough activity; instead, having 2 or more lesions, 1 or more clinical attacks, or. noticeable disability on examination are “good guiding principles to follow.”

Fox emphasized the importance of not immediately switching therapies should a new lesion appear, especially if the patient is tolerating that treatment well—and has been on it for several years. A better time to raise the alarm is if lesions start to stack up over time. Newsome added here that in conjunction with watching the lesion total, to repeat MRIs at shorter intervals; perhaps every 3 to 6 months instead of yearly.

See the entire video here.