Brain Health Assessment Challenges in MS

EP: 1.Overview of Multiple Sclerosis

EP: 2.Cognitive Decline Presentation in Patients With Multiple Sclerosis

EP: 3.Cognitive Dysfunction Clinical Assessments for Multiple Sclerosis

EP: 4.Initiating Conversations Around Cognitive Health for Patients With MS

EP: 5.The Role of Imaging in the Assessment of Brain Health and Cognition

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EP: 6.Brain Health Assessment Challenges in MS

EP: 7.Overview of Brain Atrophy Data and Cognition Research in MS

EP: 8.The Role of S1P Modulators in Multiple Sclerosis Management

EP: 9.Efficacy and Safety of S1P Receptor Modulators in Multiple Sclerosis

EP: 10.Impact of S1P Modulators on Brain Volume Measures in Multiple Sclerosis

EP: 11.Safety Considerations and Monitoring for S1P Modulators in MS

EP: 12.Using Neurofilaments as a Biomarker in MS

EP: 13.Treatment Sequencing in Patients With Multiple Sclerosis

EP: 14.Emerging Therapies and Future Directions in MS

EP: 15.Practice Pearls for the Management of Multiple Sclerosis

Stephen Krieger, MD: Dr Nicholas, how about you? You’ve heard here overall, a sense of atrophy, based upon third ventricular width. Do you have a preferred measure or way that you look at atrophy in your practice?

Jacqueline Nicholas, MD: I think looking at atrophy has been such a challenge. Certainly, when we see somebody initially, looking at T1 hypointensities is one component that I take a peek at, and certainly third ventricular width is a nonscientific way of gauging it.

Stephen Krieger, MD: It’s the quick and dirty way.

Jacqueline Nicholas, MD: I know, when I was first learning about MS, one of my mentors said, “You know, at a young age you should barely be able to slip a sheet of paper through that third ventricle.” And then seeing the width that some of these patients had was certainly eye-opening. But I would say that a bigger challenge is assessing that year-to-year or even over a couple of years. There are a lot of different ways to measure brain volume and have certainly tried to implement some of those in our practice, but I found a variation just based on time of day, if they were hydrated or not for the scan, which is obviously a challenge in MS when you have bladder issues. I think in clinical practices outside of research, it has been something hard to be able to home in, but I’m certainly hoping that we have better ways to do that across the board over time.

Transcript Edited for Clarity