MS: After Suspicious Scan, Just Wait and See?
So you go to the neurologist for, say persistent migraines, and the doctor orders an MRI. What happens if that scan turns up signs that you might have multiple sclerosis, even though you have no symptoms?
That's the question raised by a provocative study published Wednesday in the on-line edition of the journal Neurology. Researchers led by Darin Okuda at the University of California, San Francisco tracked 44 people whose brain scans -- conducted for reasons having nothing to do with MS -- revealed abnormalities that looked like the damage caused by MS, a chronic, incurable autoimmune disease. Within a median of 5.4 years, 10 of those patients had developed clinically diagnosed MS. Of the 41 people who had followup scans, 24 showed signs of further damage suggestive of MS.
As recently as two decades ago, an MS diagnosis was a hopeless thing, as there were no drugs to modulate the disease's progress. Today a handful of injectable medications are available. None cures the disease, but many people -- including me, after my 2001 diagnosis via MRI and lumbar puncture -- have apparently benefited from the drugs' ability to alter MS's progress.
Of the participants in the University of California study, seven chose to go on medication. Despite having no clinical symptoms, they started treatment for MS following the initial, suggestive MRI.
Most MS experts believe that early diagnosis and treatment are key in keeping the disease under control. Untreated (and, sadly, even sometimes when it is treated), MS can cause anything from mild symptoms such as occasional tingling and numbness to more severe disabilities such as difficulty walking, impaired vision, and even death.
An editorial (written by Dennis Bourdette of the Oregon Health & Science University in Portland) accompanying the article argues that you can't treat for MS on the basis of a suspicious MRI alone; without symptoms or other physical signs of the disease, treatment's not warranted, he says. And indeed, for those in the study who didn't develop MS, treatment -- which can cost several thousand dollars a month -- would have been out of line.
But what about the folks who did end up with MS? Might their disease have been prevented, or at least slowed, had more of them been treated on the basis of their MRIs alone?
The dilemma extends far beyond the realm of MS. As more and more people are undergoing body scans for all kinds of reasons, lots of pathologies that might otherwise have gone undetected are turning up. That's a mixed blessing: Accidentally catching sight of a tumor allows you to treat it, perhaps giving doctors the upper hand. But scans also raise the possibility of false positives and further unnecessary testing, as well as the specter of expensive and sometimes debilitating treatment for diseases that might have remained unnoticed for years.
And with MS, a complicated disease to diagnose and treat, matters aren't cut and dried. The disease's course is unpredictable, with or without treatment, and there's no telling who's going to have a mild case and who will have it worse.
I am forever thankful to have been diagnosed early and to have access to medicine that seems to be keeping my symptoms at bay. But many people opt not to go on medications even after they're diagnosed, preferring to wait and see if and how the disease develops.
What about you? If your MRI showed tell-tale signs of MS, would you clamor for treatment? Or would you be willing to wait for more definitive evidence of disease to appear?
Jennifer LaRue Huget
December 12, 2008; 7:00 AM ET
Categories: Chronic Conditions
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