Can MS lesions shrink without disease progression?

Question

Hello, doctor,

I am a 34-year-old female. Last year, I was diagnosed with multiple sclerosis (MS). I had a magnetic resonance imaging (MRI) scan with contrast last year, which showed lesions in the brain, and two were active at that time. I had another MRI last week and got my results today. It shows no new lesions or activity; also, the lesions I had have shrunken. Is this a good sign? I read that if lesions heal, that means the MS is progressing. Is this right? I have had dizziness for over a year, and it is not going away. I cannot understand it, as I have no active lesions, and the ones I did have are healing.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your question carefully, and I will try to give you a detailed answer.

There are several types of multiple sclerosis, more precisely, four.

1. The first type is the most common one, relapsing-remitting, with temporary periods of exacerbation and feeling well between attacks.

2. The second type is secondary progressing, which means that after some time in the first type, the lesions could transition to the second type, where symptoms worsen gradually.

3. The third type is not so common: primary progressive, when, from the beginning, patients have slowly worsening symptoms.

4. The rarest type, progressive relapsing, with slowly worsening symptoms, accompanied by acute exacerbation, with no remission.

So, periodic clinical and imaging evaluation should classify the type. In general, conventional magnetic resonance imaging (MRI) measures do not fully correlate with clinical standards. Said someone might have more lesions in MRI and feel better than someone who has fewer lesions.

In current medical practice, MRI features that correlate more to progression are accelerated brain volume loss (atrophy) and the formation of black holes (permanent damage to axons), which indicate more degeneration. About half of them will go away, providing the sign of remyelination. When they remain, it is a sign of permanent scarring.

I hope I was clear in my answer.

Feel free to ask further questions anytime.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

There is a study where atrophied lesions could be related to neurodegeneration, hence disability and progression. And the research was done with a powerful magnetic resonance imaging (MRI) machine (3T) that is not possessed and used regularly in everyday clinical practice. But atrophied brain lesions are very distinct from other disappearing and shrinking lesions, described in your case, which may be related to the beneficial repair. So, I would not worry about your results.

However, if you still feel in doubt, I recommend consulting your (neuro) radiologist for a more detailed explanation of your MRI scan. I do not recommend any specific issues, especially new studies, where the interpretation of results and terminology is not so easy to understand and use for non-healthcare professionals. It may lead to misunderstanding and unnecessary stress and concern.

I hope I answered your question.

Thank you.