Monitoring the brain in MS
An important part of managing your multiple sclerosis (MS) is keeping a close eye on how your condition is developing – something your doctor and MS nurse will be keen to monitor. Knowing whether your condition is under control, or if it’s getting worse, can help your neurologist understand how well your current treatment is working, and can support them in ensuring your MS is being managed in the best way possible at all times.
- Measurements based on your MS symptoms
- Measurements based on what’s going on in your brain
- The number and size of lesions (an area of the central nervous system that has been damaged or scarred by MS)
- The location of lesions
- Whether the lesions are active
- The degree of brain atrophy (shrinkage), although special software is needed to measure this which is not yet widely available
There are a number of ways to keep track of your MS and how it’s changing over time (or how it’s progressing), and these can be split into two types:
Usually, your doctor or MS nurse will use a combination of these measurements to get a full picture of how your MS is progressing.
Seeing what’s going on in your brain has become much easier since the invention of magnetic resonance imaging (MRI). MRI is now one of the most useful tools for keeping track of your multiple sclerosis and finding out how well your treatment is working.
MRI works by using strong magnetic fields and radio waves to create a detailed image of your brain and spinal cord.
Your doctor or MS nurse can use these scans to see the size and number of lesions in your central nervous system. By comparing your MRI scan to previous scans, your doctor or MS nurse can work out whether your multiple sclerosis is stable or active and, importantly, whether your current treatment is working.
Discover more about the impact MS can have on your brain.
You may or may not have had an MRI scan before, but they can cause some people anxiety. Here’s some information to explain what you can expect...
When you have a scan you’ll lie down on a bed that slides into a large tube, which is surrounded by a circular magnet. Because of this magnet, you’ll be asked to remove all metal from your body, including jewellery, piercings, hearing aids and dentures.
You’ll also be asked if you have any medical devices that contain any metal such as a pacemaker, a copper intrauterine device (IUD), artificial joints or if you have any broken bones that have been repaired with metal screws or pins. But don’t worry, having metal in your body doesn’t necessarily mean you can’t have an MRI scan. Medical staff will assess whether you can go ahead with the procedure and can take any precautions needed to ensure your safety.
Before or during the scan, you may be given an injection of a type of fluid, which makes any active lesions visible on a scan. This fluid is a type of contrast dye called gadolinium. If having an injection makes you feel anxious, let your doctor or MS nurse know as they may be able to reassure you and put you at ease. It’s also important to tell the technician if you are pregnant or think you might be pregnant, or if you are breastfeeding.
It takes about 30 minutes to an hour to take all of the different scans. It can be quite noisy but the technician operating the scanner will be able to hear you and to speak to you, so you can talk to each other at any time. When the scanner is taking a scan, the technician will ask you to stay as still as you can so they can get a clear image. If the idea of lying in the scanner worries you, let your technician know as they may be able to make the experience easier for you.
For some people, going for an MRI scan may be a difficult experience. Keeping still in a cool room and in a relatively confined space can be uncomfortable. You may find it an even bigger challenge if you suffer from stiffness and experience pain when staying in the same position for too long.
Feel free to share any concerns you may have with your MRI technician, as they may be able make the experience easier for you, such as breaking the scan up into shorter segments. If having an MRI scan makes you a little anxious you might want to try some relaxation techniques that may help you to have a more stress-free experience.
MRI scanners are big pieces of equipment and are often put in large rooms which can get quite cold, so you might want to wear warm clothing to your appointment – but remember to choose something without metal zippers or buttons.
After your MRI scan is finished your doctor or MS nurse will be sent the scans and may discuss the results with you in an upcoming appointment. Using the scans, your doctor or MS nurse will be able to look for different signs of damage, including:
MRI scans are especially important, as they can detect lesions that are linked to your symptoms as well as any silent lesions that may be occurring even when you’re feeling well with no symptoms or relapses.
- Giovannoni G et al. 2017. Brain health: time matters in multiple sclerosis. Available at: https://www.msbrainhealth.org/report Last accessed: October 2017.
- MRI Scan – How is it performed? Available at: http://www.nhs.uk/Conditions/MRI-scan/Pages/How-is-it-performed.aspx. Last accessed: October 2017.
- MRI and MS: 7 things you need to know. Available at: https://www.mssociety.org.uk/ms-research/research-blog/2017/02/mri-and-ms-7-things-you-need-know. Last accessed: October 2017.
- Relapsing remitting MS. Available at: https://www.mstrust.org.uk/a-z/relapsing-remitting-ms-0. Last accessed: October 2017.
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