Innovations In Clinical Neuroscience

MAR-APR 2017

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 4 , N U M B E R 3 – 4 , M A R C H – A P R I L 2 0 1 7 ] 40 MRI findings also suffer from intra- and inter-rater differences, these data are permanent, retrievable, and can be analyzed by unbiased radiologists anywhere in the world. Data can be stored and standardized for longitudinal studies and retrospective analyses are possible. More importantly, the pharmaceutical industry benefits from this deluge of digital data—or "big data"—through sharing and data mining and is ideally positioned to design better therapeutic options for patients based on MRI metrics. A new vision to manage the burgeoning MRI data accumulating in acute MS relapses and transform all this "big data" into "big brain science" is urgently needed. Lastly, high-field MRIs, though only in research use thus far and complicated by artefactual noise, promise to bring more to the MS relapse world, among other brain disorders. CONCLUSION A better definition of what constitutes a relapse in MS is urgently needed. From a treatment perspective, the management of relapses, particularly in the emergency department (ED), is highly variable. In general, it is possible that patients are treated with steroids based on symptomatology and an ED physician's evaluation. It is often difficult in the ED to ascertain baseline status or a deviation from it, and an MRI may or may not be performed in the ED owing to cost and availability. However, if objective MRI data are not the singular surrogate biomarker to validate BBB breach, false-positive cases are probably subjected to unneccessary treatment in clinical practice, and false-positive cases may inaccurately "improve" a drug's efficacy in clinical research. As MRI techniques improve, it is only a matter of time before a gold standard based on imaging will emerge. Clinical skills and evaluations, meanwhile, are probably stagnant, at best. It is time to ditch the current definition of an MS relapse. Routine MRIs should be performed on all patients with MS. If the BBB is intact, then the patient should not be diagnosed as having an acute relapse. REFERENCES 1. Schumacker GA, Beebe G, Kibler RF, et al. Problems of experimental trials of therapy in multiple sclerosis: Report by the panel on the evaluation of experimental trials of therapy in multiple sclerosis. Ann N Y Acad Sci. 1965;122:552–568. 2. Guthrie TC, Nelson, DA. Influence of temperature changes on multiple sclerosis: critical review of mechanisms and research potential. J Neurol Sci. 1995;129(1):1–8. 3. Davis FA. The clinico-radiological paradox in multiple sclerosis: novel implications of lesion size. Mult Scler. 2014;20:515–516. 4. Lublin F. Disease activity free status in MS. Mult Scler Relat Dis. 2012;1:6–7. 5. Jacobs LD, Cookfair DL, Rudick RA, et al. Intramuscular interferon beta-1a for disease progression in relapsing multiple sclerosis: the Multiple Sclerosis Collaborative Research Group (MSCRG). Ann Neurol. 1996;39(3):285–294. 6. Wolansky LJ, Finden SG, Chang R, et al. Gadoteridol in multiple sclerosis patients: a comparison of single and triple dose with immediate vs. delayed imaging. Clin Imaging. 1998;22(6):385–392. 7. Silver NC, Good CD, Barker GJ, et al. Sensitivity of contrast enhanced MRI in multiple sclerosis: effects of gadolinium dose, magnetization transfer contrast and delayed imaging. Brain. 1997;120(Pt 7):1149–1161.

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