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with no drugs at all can a person with ms have an mri look calm and show no enhancing lesions?

Yes, Robbie it can.

I was diagnosed in 2003 - my MRI showed lesions but none were enhanced or active and there was no inflammation. For that reason, I decided to not go on any of the CRAB drugs. My yearly MRI scans have not changed since 2003. I started LDN in May of 2008 and I just had my 2009 MRI - everything is still stable.

Sharon

the picture they see at the moment that the mri was taken is how they decide on the sucess of a drug or not. not sure how this works.
thanks sharon

Hi Robbie.

A friend of mine has PP MS. His MRIs have been identical since 1998 and he has been on azathioprine for several periods during all these years, with long pauses between them, because of liver issues. His symptoms get constantly worse, however, either he is on treatment or not and despite "MRI silence".

MRI is just a picture. We don't know what exactly is happening in the heart of these lesions, we are not sure if they contribute to disability and, most importantly, we have no idea about what caused them. Yes, yes, I know, it is the bad immune system. But nobody can point to a proof.

Anyway, I wouldn't mind if I had 10000 lesions, as long as I could live my life normally. It is the disability that should be the only measurement to determine a drug's efficacy, not dots on a photo. But reducing disability is hard. Reducing dots is easy.

Let me say an example. My uncle used to have a farming machine (I don't know how it is called in English). While he was using it, the "overheat" lamp went on. He turned off the machine till it went off, again. Then, he continued his work. Half an hour later, the light went on again. He stopped working, again, and continued after a while. To make it short, he stopped about 5 times. It was then that he decided to remove the lamp, so that it does not light again and interrupt his work. Of course, the machine completely failed after an hour.

Making the light not shine is easy, but finding the cause that makes the machine fail is very difficult. Lesions are just indicators of something going wrong. Nothing more, nothing less. Removing the indicator can not solve the problem. And behaving as if the indicator is the cause could lead to disaster.

sou

Yes, sou, I get your point.
One thing is certain, you can't have ms and no lesions.
The other certain thing is that there is no proven connection b/n number of lesions and disability, meaning you can have one lesion and be wheelchair-bound and many and have no disability problem. Then, the right question which is raised here and which I have asked myself many times is: In those experiments they always evaluate mri and enchancement of lesions or their reduction... - how then, when there's said to have no connection, how can these evaluations be correct?

I was diagnosed in 2003 - my MRI showed lesions but none were enhanced or active and there was no inflammation. For that reason, I decided to not go on any of the CRAB drugs. My yearly MRI scans have not changed since 2003. I started LDN in May of 2008 and I just had my 2009 MRI - everything is still stable.

if sharon went on one of the crabs right away like the doctors want you to would they say the 6 years of her ms being stable is because of the crab of choice or is it just her paticular ms.

Petakitty--I agree with you when you said:

I am starting to think MRI's don't mean a whole heck of a lot.

How can the experts explain people who never had lesions on MRI, but have undeniable MS symptoms for decades? Or who worsen over time in symptoms, but never in MRI and lesion status?

I think MRI is used on people SUSPECTED of having MS, and, of course, lesions must be involved if they are found (but many "normal" people are found to have lesions???)!

Good question, Robbie -

if sharon went on one of the crabs right away like the doctors want you to would they say the 6 years of her ms being stable is because of the crab of choice or is it just her paticular ms.

And, yes the neuro wanted me to go on a CRAB drug.

In my opinion, I was RRMS for many, many years before being diagnosed. I had slipped into SPMS at time of diagnosis, but I was told that I was RRMS which would have made me a candidate for the drugs. And, yes I think that some doctors would have told me that I was stable because of the CRAB drugs (if I had been taking them). I am just glad that I did my research and saved myself from the daily shots, the flu symptoms and all the other stuff which is associated with the CRAB drugs. I am not implying that the CRAB's are not a useful drug - they just did not apply to me. Another reason I did not take a CRAB is because my brother was taking BetaSeron and he was sick every third day. I decided that I did not want to waste 1/3 of my life.

My disability has gotten worse since 2003 even though the MRI's are the same. I am also fighting the gift of time as I am almost 66 yrs of age. So, I question, "is it MS or is it age?" The answer usually is what fits the puzzle at the time. I am fortunate to be able to do just about anything I want as I know there are those much younger who are dealing with greater disability problems than I have.

Sharon

Robbie-

Check out the pics from the new 7Tesla MRI machines (Tesla is the measurement for the magnetic power of the machine, most MS folks have been tested by .5-1T machines). Docs are able to see what's going on in the MS brain with more detail now. There's a super monster 9Tesla machine being developed.

7Tesla Pics

What the docs are noticing is that there are first subtle changes in the blood vessels in the brain.

7T MR provides sophisticated imaging capabilities by virtue of increased signal intensity and susceptibility effects, the fundamental quantities underlying image resolution and contrast, respectively. Our findings established that approximately half of total MS lesions in our two patients are small with well-defined central veins, and that these diffuse, subtle signal abnormalities may correspond to early vascular changes. This represents the first time that such subtle vascular inflammatory abnormalities have been demonstrated in vivo. Improved detection of these lesions in the early stage of development on 7T MRI will have substantial ramifications on future diagnosis, monitoring, and therapeutic response in MS. Therefore, utilizing ultra-high-field MRI for precise characterization of microvascular abnormalities in early MS lesion development may allow for immediate
pharmacologic intervention directed at these initial changes.

We may find out in the future that it's not about the lesions...but about the vascular changes in the brain. My personal belief is that the "subtle vascular inflammatory abnormalities" is what keeps MS progressing. The current machines are useful for diagnosis, and keeping the drug companies in business. That's about it!
AC

There are very few MRI units that are above 3t that would be available to any of us with such a common ilness as MS.
1.5 t is quite good actually, as long as it's not an open one.
The newest 1.5, and 3ts are being made with a much shorter bore. You can see completely from end to end, and the magent housing is down to about 4 feet so it's way less coffin like.
I still take the claustrophobia drugs though, just in case..

Point is, if MS is primarily vascular, and the current MRIs are not able to show true disease progression, why bother?

Multiple sclerosis (MS) lesions have been linked to venous abnormality, although the derivation of these lesions from the vasculature has been difficult to assess in vivo (1,2). Ultra-high-field (e.g. 7T) MR has provided increased visibility of venous vasculature by taking advantage of markedly increased intrinsic intensity and susceptibility contrast (3). We report findings acquired at 7T MR in two MS patients, and demonstrate enhanced detection of unique microvascular abnormalities in MS.

Here's a clinical trial for MS patients using 7Tesla MRI....
http://clinicaltrials.gov/ct2/show/record/NCT00321568
AC

Kitty...you might want to size down your Sham Wow! pic-