ACTRIMS 2020 News Network: Updated Recommendations for Standardized MRI Protocol in MS


Patricia K. Coyle, MD: There was a very important late-breaking abstract that presented the most recent recommendations on standardized MRI [magnetic resonance imaging] for the brain and the spinal cord in MS [multiple sclerosis]. This has gone through several revisions. The good news is that they coalesce the recommendations of the Consortium of Multiple Sclerosis Centers, or CMSC, and MAGNIMS [Magnetic Resonance Imaging in Multiple Sclerosis], which is the big MRI group from Europe. They've had somewhat different recommended protocols. They coalesced them, so they've united together. They've also made them extremely practical. They talk about using 3D with no gap whatsoever. They put some suggested limitations on the use of gadolinium contrast, saying that it should be used for the diagnosis of MS and if there is suspected worsening, but saying that if it is going to be at the same center and you can make a direct comparison, you probably don't need to do it at other times. This is very important because we need to standardize how we do MRI scans in patients with MS or suspected patients with MS. This gives the state of the art compilation of experts from the United States and Europe who have now agreed on what they think are the best protocols.

There is a very important feature here. This needs to be accepted. This needs to be taken up, and they really have built in a program where there will be webinars to try to get that done. We need the buy-in of radiology and neuroradiology as well as neurologists, and they're also going to have cards that actually outline the protocols, which they have tried to simplify and make it as straightforward as possible. I think you're going to see a big push to really get people to accept this, and I think this will be a huge movement forward in taking care of MS if we can get everybody to agree on this protocol.

There were a few other things that were very interesting at the ACTRIMS [Americas Committee for Treatment and Research in Multiple Sclerosis Forum] 2020, but this had a big push on talking about various types of networks, including social networks. I was shocked to learn that social isolation, which means you have 5 or fewer close friends whom you deal with, is associated with a 29% increased risk for mortality. Being socially isolated is the equivalent of smoking ¾ of a pack per day of cigarettes as a negative health outcome. That really surprised me.

In addition, there was a very interesting discussion about epigenetics and methylation in MS. Their data is suggesting that patients with MS are phenotypically aging, show greater aging than matched controls, and I think this will be something very important to look at further.

There was also a very interesting preliminary report—the study is still blinded—of a nanotechnology study for chronic optic nerve and vision loss in patients with MS, where they're looking at crystal gold nanoparticles to boost CNS [central nervous system] repair. Believe it or not you have a quadzillion particles that you drink, take by mouth, 60 mL daily, that get into your brain, and they're looking to see if it actually promotes CNS repair. This is a small study, but it's expanding. It's still in the blinded stage, but I thought that was really very interesting. So, stay tuned.

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