Current Series: Advances in the Management of Relapsing Multiple Sclerosis

Fred D. Lublin, MD: MRI [magnetic resonance imaging] has been a key technological advance for multiple sclerosis since the early 1980s, when it was first utilized. No other tool is as sensitive in picking up the lesions of multiple sclerosis, and we know this because individuals can have 10 to 20 MRI lesions for every 1 that expresses itself clinically. So it’s remarkably sensitive. It’s been very useful as a surrogate for diagnosing multiple sclerosis, and now we’re using it to follow the illness. We are routinely scanning individuals over time. We haven’t yet developed criteria for how and when to change someone if their MRI is changing, but it’s been a very useful tool for gauging disease activity.

Robert J. Fox, MD: An important thing we have learned over the past 5, 10 years is the importance of MRI to augment our understanding of the disease. Patients may look fine, but if there are new lesions and active lesions on MRI, we know that is a harbinger of bad things coming down the line. Even in patients who are clinically stable, when there are new or active lesions on MRI, that represents that the disease is not successfully controlled, and we generally move to a different therapy.

Back when I was in training we were taught to treat the patient, not the test. MRI has helped us understand that you don’t treat the patient or the tests. You treat the disease. You treat the disease with a patient there, using the tests to understand the disease. MRI has helped us understand the disease, so we use both the patient and the MRI to get at and successfully treat the disease.