Medical Imaging for MS Diagnosis: Understanding MRI Scans

Multiple Sclerosis (MS) is a chronic autoimmune disorder of the central nervous system (CNS). It’s a condition that affects the brain and spinal cord because the body’s immune system mistakenly attacks the myelin that surrounds nerve fibres.

Because myelin is a protective coating for the nerves, when it’s attacked, this causes inflammation and damage. This inflammation and damage results in a variety of symptoms.

MRI Scans are critical in identifying lesions or inflammation that can lead to an MS diagnosis.

Although the underlying cause of MS is not fully understood, research points to a combination of genetic and environmental factors. While there is no cure for MS, there is a growing awareness of the condition, and there are treatments that can help manage symptoms and slow disease progression.

What are the symptoms of MS?

The reality is that MS causes a wide range of symptoms, some of them invisible, and symptoms vary from person to person. These varied symptoms depend on the location and severity of nerve damage, which make MS unpredictable. However, there are some common symptoms which include:

Vision problems: A common early symptom is blurred or double vision, optic neuritis, eye pain, involuntary eye movements, and sometimes partial or complete vision loss.
Fatigue: MS-related fatigue is the most common symptom with 75%-95% of MS patients experiencing it at some stage of the disease. Fatigue is an overwhelming and debilitating sense of tiredness that can occur even after a good night’s sleep.
Numbness or tingling: MS can cause a pins-and-needles sensation, numbness, or feeling that a limb has fallen asleep – for example in the face or extremities.
Muscle weakness or spasticity: MS can cause weakness or stiffness as well as spasticity. These symptoms are not mutually exclusive– one can occur without the other. MS usually affects the legs more than the arms, making it difficult to stand, walk, or transfer weight.
Balance and coordination problems: Because MS can affect the legs, sufferers are prone to balance issues and falls.
Bladder or bowel dysfunction: MS can cause bladder or bowel dysfunction, leading to urinary incontinence, urgency, or constipation.
Cognitive and emotional changes: MS can cause cognitive changes such as difficulty with memory, attention, or problem-solving. The physical and emotional challenges of MS can also contribute to depression, anxiety, or mood swings.
Pain: MS can cause various types of pain, including headaches, neuropathic pain, and musculoskeletal pain.

Types of MS

Despite being unpredictable, there are four main types of MS, which are defined by the pattern of disease progression:

1. Relapsing-remitting MS (RRMS

Relapsing-remitting MS (RRMS) affects about 85% of people living with MS and is the most common type. RRMS is characterised by periods of relapse– during these periods new symptoms or a worsening of existing symptoms occur. Thereafter there’s a period of remission, during which symptoms improve or disappear. In RRMS, the disease may progress over time, leading to increased disability.

2. Primary progressive MS (PPMS)

Primary progressive MS (PPMS) affects about 10% of people with MS. It is characterised by a gradual progression of symptoms and disability from the onset of the disease. There are no remission periods, and PPMS tends to progress quicker than RRMS. Unfortunately, there are currently fewer treatment options available.

3. Secondary progressive MS (SPMS)

Secondary progressive MS (SPMS) typically develops in people with RRMS who have experienced a gradual worsening of symptoms over time. With SPMS, there’s a progressive worsening of symptoms and disability, with or without relapses. At present, there are several disease-modifying therapies available for this type of MS.

4. Progressive-relapsing MS (PRMS)

Progressive-relapsing MS (PRMS) is a rare form that affects about 5% of people with MS. It’s characterised by a steady progression of symptoms from the onset of the disease, with occasional relapses or exacerbations. PRMS tends to progress more quickly than other forms of MS, and there are currently limited treatment options available.

Risk Factors

While there is no definitive reason as to why certain people develop MS, there are factors that may increase the risk.

Although MS can affect any age, typically, it occurs between 20-40 years. Women are also 2-3 times more likely to have RRMS. White people are at higher risk of developing MS, whereas Asian, African, or Native Americans have the lowest risk.

MS has been attached to genetics and family history, so if it runs in your family, you are at higher risk. There’s also a gene on chromosome 6p21 that is associated with MS.

People with other autoimmune diseases such as thyroid disease, pernicious anaemia, psoriasis, type 1 diabetes, or inflammatory disease may also be at greater risk.

MS has also been linked to vitamin D deficiencies, obesity (especially childhood and adolescent obesity in females), and smokers.

How is MS diagnosed?

Owing to the range and broad nature of the symptoms, diagnosing MS can be challenging. There is also no single test that definitively diagnoses the condition. Typically, healthcare providers use a varied combination of tests and assessments to make an accurate diagnosis.

These are some of the steps that may be involved in diagnosing MS:

Medical history and physical exam: If you experience any symptoms of MS your healthcare provider will consult regarding your symptoms, medical history, and family history of MS. They will also perform a neurological exam to assess some of your CNS function, including reflexes, muscle strength, and coordination.
MRI scan: An MRI (magnetic resonance imaging) scan of the brain and spinal cord can help to identify inflammation or lesions that may be associated with MS.
Lumbar puncture (spinal tap): Lumbar punctures, which take a sample of cerebrospinal fluid (CSF) from the spinal canal, can detect abnormal levels of certain proteins indicative of MS.
Evoked potentials: These are tests to measure the brain’s response to visual, auditory, or sensory stimuli and whether there are abnormalities that may point to nerve damage or dysfunction.
Blood tests: Blood tests can help rule out other conditions that can cause similar symptoms.
Clinical criteria: The McDonald criteria are a set of guidelines used to diagnose MS based on a combination of clinical and imaging findings.

The Role of MRI Scans in Diagnosing MS

When it comes to diagnosing MS, MRI scans play a crucial role and are often used in combination with other tests and assessments to make an accurate diagnosis and develop an individualised treatment plan.

The benefit of MRI is it’s a non-invasive imaging technique that uses a magnetic field and radio waves to produce detailed images of the brain and spinal cord.

MRIs are useful because they detect the damage to the myelin sheath that causes MS. The damage appears as lesions or areas of inflammation in the brain and spinal cord. The benefit of an MRI is that it can detect myelin damage before symptoms of MS occur. In some cases, to get an even more detailed picture of what’s going on inside the brain and spinal cord, they might perform an MRI with contrast where they inject a gadolinium-based dye.

MRI scans can also indicate whether the disease is active or inactive, monitor disease progression, and assist in evaluating the efficacy of treatment over time. And, when it comes to ruling out other conditions, such as tumours or infections, MRIs can be invaluable.

Three axial MRI images illustrating the clinic-radiological paradox of multiple sclerosis:
a 52-year-old male (benign) relapsing remitting multiple sclerosis (RRMS) patient, disease duration of 23 years, expanded disability status scale (EDSS) score of 2.5
b 50-year-old female RRMS patient, disease duration of 11 years, EDSS score of 3.0
c 53-year-old female primary progressive multiple sclerosis (PPMS) patient, disease duration of 7 years, EDSS of 4.5.
Source: https://doi.org/10.1007/s00062-015-0430-y

Treatment options

While there’s currently no cure for MS, there are several treatments that can help slow disease progression, manage symptoms, and improve quality of life.

Currently, the best treatment plan is on a case-by-case basis. This means that an individual’s specific symptoms and disease course, as well as their overall health and lifestyle, should be considered. Once an individual’s case is assessed, the following can be considered:

Disease-modifying therapies (DMTs): There are several types of medications, DMTs, to help slow disease progression, reduce relapse rates, and decrease inflammation in the CNS.
Symptomatic treatments: These treatments manage the specific symptoms that an individual is experiencing. Symptomatic treatments improve quality of life and certain medications, physical therapy, occupational therapy, and speech therapy can be highly beneficial.
Lifestyle modifications: Modifications to exercise, diet, stress, hygiene, and sleep can help manage MS symptoms and improve overall health and well-being.
Supportive therapies: Psychological counselling, cognitive rehabilitation, and vocational rehabilitation, can help manage the emotional and cognitive effects of MS and support a person’s quality of life.
Alternative therapies: Although their efficacy is not well-established, acupuncture, massage therapy, and herbal supplements may offer some benefits. However, they shouldn’t be used as a substitute for standard medical care.

Living with MS

Although MS is no doubt exceptionally challenging, there are several things that people living with MS can do to improve their overall quality of life.

Try to keep moving and eat a healthy diet

MS can feel like you’re been given a life sentence, and it’s normal to struggle with depression and daily fatigue. While it may sound counterintuitive, regular exercise can help reduce fatigue and increase energy levels. Plus, the endorphins from exercise are an excellent way to boost mood and reduce depression and anxiety.

Staying as active as possible also improves overall strength, flexibility, balance, and mobility. Exercise also helps with heart health, improves cognitive function, and may help reduce inflammation.

Aside from regular exercise, eating a balanced diet that is rich in fruits, vegetables, lean protein, and whole grains can help support overall health and well-being. Research also suggests that eating smaller portions more regularly can help with fatigue. Reducing processed foods, sugar, and saturated fats can help with inflammation, and increasing fibre and fermented foods can help with gut health.

It’s important to talk to your doctor about what types of exercise are safe and appropriate for you before embarking on an exercise plan. You should also consult with a healthcare professional or registered dietician to develop a personalised dietary plan.

More rest, less stress

Rest is an integral part of managing fatigue and other MS symptoms. You should be getting 7-9 hours of sleep every night, and it’s a good idea to take breaks or have naps as needed throughout the day. Sleep helps the immune system to recover and promotes healing and repair. Sleep is also vital for good cognitive function and to manage one’s mood.

People with MS should establish a regular sleep schedule, create a routine around bedtime, and avoid caffeine and alcohol before bedtime. You should consult with your healthcare provider if you are struggling to sleep.

Being well rested will reduce your overall stress level, and reducing stress is vital in managing MS. Try stress-relieving activities such as meditation, deep breathing, yoga, reading, or listening to music. Stress and lack of sleep are linked to exercise and diet so it’s a good idea to factor all of these elements into your lifestyle.

Find support

Whether support comes from family, friends, your healthcare team, or other people with MS, you need to know that you’re not alone. MS can be lonely and isolating, so reaching out can be hugely beneficial.

Having a sense of community and support is so important, especially when dealing with big changes. You should never feel afraid or embarrassed to reach out to your friends or family or to join an MS support group. Knowledge is power, and learning from other people’s experiences and gaining practical advice will make living with MS easier.

You should also have regular check-ups with your doctor to ensure you are receiving the right treatment. MS symptoms can change so it’s important to manage medications and treatments. Depending on your symptoms, you may also want to consider using assistive devices like canes, walkers, or braces to improve your overall mobility.

Do you have MS? This is what you can do.

Once diagnosed, MS is for life, but that doesn’t mean it has to be your life. Remember that every person with MS is unique and experiences the condition differently. What works for one person may not work for another, and it’s not a one size fits all model of treatment. You are not alone, though, and learning from other people’s experiences of MS can help you to feel less isolated.

The first step is to get a proper diagnosis and to discuss treatment options. Therefore it’s important to work closely with your healthcare team to develop a personalised plan for managing your symptoms and improving your quality of life.

If you’re based in Namibia, visit ERAD’s branch in Walvis Bay for a consultation.

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Header image by freepik

Diagnosing Multiple Sclerosis (MS) with MRI Scans

What we’ll cover:

What are the symptoms of MS?