I’m both recovering from jet lag and adjusting back to my cultural and climatological norms. It’s been a slower “recovery” than I’d expected, and it’s taken me longer than anticipated to dig through my MS inbox for new information that you might find interesting. Today I found something for those wondering about secondary-progressive multiple sclerosis (SPMS), a stage of MS that follows relapsing-remitting MS.
How Is SPMS Diagnosed Now?
SPMS is historically difficult to diagnose in real time, as discussed by neurologist Avindra Nath, MD, in an interview in PracticeUpdate. Even though a large proportion of people diagnosed with relapsing-remitting MS (RRMS) will go on to develop to SPMS — according to Dr. Nath, 85 to 90 percent transition within about 20 years — it has long been diagnosed only in retrospect, after a person has gone a number of years with few or no relapses but has experienced symptom progression, or increased disability. Though biomarkers would be a preferred method of diagnosis, the only currently reliable method for determining the transition from RRMS to SPMS has been the extensive review of clinical markers (aka signs and symptoms) over a number of years. This process requires accurate symptom reporting by patients as well as extensive notes and follow-up by the MS medical team.
How Are Biomarkers Currently Used in MS Management?
A bit of background for those who might like some clarification: One of the biomarkers of RRMS would be evidence of inflammation on an MRI scan. These are those bright spots we have grown uncomfortably used to seeing on images of our brains and spinal cords. SPMS is considered a noninflammatory phase of the disease. That is to say that the damage done to the brain, and the clinical presentation in symptom progression, is caused less and less by inflammation. Knowing what to look for beyond white spots and lesions on an MRI could help to corroborate clinical observations of progression without attacks and subsequent inflammation. This has become increasingly important as new drug treatments targeting SPMS have been approved, and more are in the clinical trial pipeline.
Special MRI Technique Identifies Tissue Damage in Brain and Spinal Cord
Now, according to a study published in February 2022 in Multiple Sclerosis Journal, researchers may have found biomarkers that could one day assist physicians in the diagnostic process. Using what is called quantitative gradient recalled echo (qGRE) magnetic resonance imaging (MRI) to evaluate microstructural tissue damage in the brain and spinal tissue, researchers have correlated biomarkers with clinical decline in people with MS. By comparing clinical observations of disease progression with these qGRE scans, the study showed close overlap of clinical symptom progression and a biomarker called R2t* (defined by researchers as a “GRE MRI signal decay rate constant”). An extensive discussion of the MRI technique used in this study can be found in an earlier paper by the same research group, published in August 2018 in Journal of Magnetic Resonance Imaging. Assuming this research can be confirmed in larger studies, and provided the MRI technique used can be made available outside the research setting, this discovery could lead to not just earlier diagnoses of SPMS, but also studies of the efficacy of new medications to treat the condition.
For Nonscientists, This Is Pretty Technical Stuff
I must admit that my jet-lagged and heat-simmered brain had a hard time getting through the technicalities of this study. The kernel of the conclusion, however, that this observation may help as many as 90 percent of people currently living with MS, was easy to discern, even if I had a hard time with the science. Wishing you and your family the best of health. Cheers, Trevis
