Research topic: Understanding "benign MS"
by Martha King
In addition to labels like relapsing-remitting MS, secondary-progressive MS, primary progressive MS, there is something labeled benign MS for people who live with MS for years without developing any disabilities at all.
Like so much else in MS, no one understands why some MS is so mild. Even the proportion of people with benign MS is unclear. Estimates range from 5 to 40 percent in different studies, and some doctors have even called for a halt in the use of this term.
Everyone agrees that benign describes the very mildest form of MS. These people have had enough neurological symptoms and MRI abnormalities to be diagnosed — but for the next 10 to 20 years, their physical disability is mild to nonexistent.
The big catch
Early on — which is the very best time to get on a disease-modifying drug — there is no way to predict who will have mild MS and who needs to start therapy as soon as possible. Teasing out the factors that distinguish the “benign” group from others would spare them from taking treatment they don’t need. The factors might also be clues to preventing more disabling MS. Researchers are eager to dig in.
Investigators in Europe are pooling their imaging expertise in an ongoing collaborative MS research project called MAGNIMS. A recent report from this project warns against assuming mild MS is truly benign.* MAGNIMS researchers found cognitive impairment in up to 45 percent of people who had been designated as “benign.” They concluded that testing to rule out cognitive problems is essential before a person is considered to have truly benign MS.
The MAGNIMS team also saw some MRI abnormalities that suggested a future of worsening MS and they identified a connection between mild MS and a brain’s ability to compensate for damage by mobilizing other brain regions. In other words, some mild MS had caused real but hidden damage.
The best idea for now
The MAGNIMS analysis adds important insights into “benign MS” — and makes a clear case for further research involving large numbers of people with mild MS. Until more is known, the Society’s National Clinical Advisory Board recommends that treatment with one of the disease-modifying MS drugs be considered as soon as possible following a confirmed MS or CIS diagnosis.
To learn more, visit www.nationalMSsociety.org/research and type “benign MS” into the search bar.
*Neurology 2009;72:1693-1701