Ask the Experts: MS Lesions
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Q: In December, 2005 my 12 year old daughter got sick with symptoms similar to MS. She fully recovered in 2 weeks, and then contracted optic neuritis. There were no bands in her Spinal fluid. In June of 2006 she had another flare-up, and MS was confirmed. She spent months in the hospital, was discharged, and by January 2007 began to experience memory problems. By June 2007, she had almost no short-term memory. She is currently on Rebif, after trying Avonex and Cytoxen and high dose steriods. Her MRI shows many lesions on the frontal lobe causing severe cognitive delays among other things. Can these brain lesions be reversed or go away?
A: Brain lesions in children with MS can sometimes decrease in size during the acute phase of a relapse, or close to the time that they start. Intravenous steroids administered at the time of the acute attack can help with this process. However, the brain lesions that remain after this acute phase are generally more permanent. Sometimes, with time and prophylactic MS treatments like Rebif, Avonex or Cytoxan, can help to reduce the size of the lesions. We also think that with time, the brain "rewires" itself, and new connections are formed. We are not sure to what extent this happens in children with multiple sclerosis, and this is an important area of research which is being undertaken. Supportive services in school and at home, as well as cognitive rehabilitation can help with "rewiring" and the formation of new connections.
Q: My fiancé has a contrasting lesion in the left temporal lobe that has been seen on his last 3 MRIs. This is in addition to multiplother lesions seen on the MRI. What does this mean in relation to his MS? Is this more severe brain damage?
A: If your fiancé's MRI continues to be contrast positive after 6 months, it may simply that there is another condition rather than MS. In general, a positive contrast study implies active inflammation and most revert to contrast negative over months. It is not a reflection of the degree of "damage" but rather reflects changes in the blood brain barrier usually caused by inflammation.
I would suggest asking the doctor to review the actual films with you and your fiancé. Some neurologists use serial MRI tests to help plan treatment programs and this information might effect decisions on whether further tests or consultation at an MS center might be helpful.
Q: Can you explain an active lesion versus a plaque? Is an active lesion also a new lesion? Can a plaque become an active lesion?
A: An active MS lesion is one in which there is ongoing inflammation around the blood vessels in the lesion, with impairment of the blood-brain barrier, as indicated by enhancement of the lesion on MRI after gadolinium injection. A plaque is a zone of damaged myelin in the brain or spinal cord. It can be old or recent. Recent plaques are usually active for up to a few weeks. A plaque can subsequently enlarge, with active inflammation around its periphery.