In recent years there have been tremendous advancements in the treatment of relapsing-remitting multiple sclerosis (RRMS). However, it’s important to understand what relapsing-remitting multiple sclerosis therapy is designed to do. The goal is to reduce the frequency of relapses and new damage to your nervous system. Unfortunately, damage that already exists may not be repaired by therapy.
RRMS therapy may help you stay as healthy as possible for as long as possible. That’s why it’s so important to stay committed to starting—and staying on—therapy. But many of the symptoms that accompany multiple sclerosis can’t be treated with the available RRMS therapies. Your doctor may work with you to treat symptoms such as bladder issues and fatigue.
Multiple Sclerosis measurement tools and techniques
Here are a few of the tools and techniques that your doctor may use to understand how well your multiple sclerosis therapy is working. Some measure recent disease activity (the development of new lesions) and others measure disease severity (how MS is affecting your CNS over time).
MRI1
Magnetic resonance imaging (MRI) is a technique that allows a non-invasive look inside the body. The person lies or stands inside a large electromagnet, which creates a highly intense magnetic field around the body. The protons, neutrons, and electrons inside the patient’s body respond to the magnetic field and form an image of even the smallest areas of damage.
An MRI can help your doctor see any recent disease activity, measured by the development of new lesions. You are probably most familiar with these types of measurements:
- GD Enhanced T1-weighted lesions: Using GD (gadolinium) enhancement (also called conventional T1), your doctor can tell which lesions are new in the last 45 days. Gadolinium is a dye that allows the MRI to show areas of active inflammation.2 This type of scan is not a strong predictor of MS-related disability.3
- T2-weighted lesions: These scans show disease activity of the past year. The images show bright spots, which indicate plaque, or lesions.2 This type of scan is also not a strong predictor of MS-related disability.3
Advanced technology and measures
These techniques can help reveal disease severity and permanent damage due to MS. Below are 2 techniques that help researchers look at different types of damage.
While these techniques are not widely used at this time, your doctor is likely learning about the scientific research findings through medical meetings and literature,
etc.:
- Chronic Black Holes: Dark areas resembling black holes that show up on T1-weighted MRI persistently for more than 6 months are known as "chronic black holes.”2,4 These areas show losses of tissue where a lesion once was. Although the significance of chronic black holes is not fully understood, they strongly correspond with MS-related disability5
- Brain atrophy/shrinkage: New research has shown that MS can cause the brain to atrophy, or shrink, through loss of tissue. This means that there is a reduction in the total volume of the brain. MS experts agree that starting on approved MS therapy as early as possible may help in slowing the process
of brain atrophy.6 Brain atrophy has a strong correlation with MS-related disability7-9
EDSS scale10
The EDSS (Expanded Disability Status Scale) is a measurement that assesses your mobility on a scale of 0 to 10 (0 indicating normal mobility). The EDSS is often used in clinical studies to examine whether treatments are having an effect on mobility (your doctor might use certain parts of this exam such as a timed 50-ft walk). However, the EDSS does not take into consideration other forms of impairment, such as vision loss or a loss of cognitive function. So a person’s true overall disability and impairment level may be difficult to determine from an EDSS score only.
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