Fig.1: In MS the transmission of nerve impulses is impaired due to the destruction of nerve fibers and myelin sheaths

Fatigue, impaired vision, numbness, dizziness, a tingling sensation in the arms or legs – most of us experience such symptoms from time to time and interpret them as signs of stress. For 2.5 million people around the world, however, they mark the beginning of a devastating chronic disease – multiple sclerosis, or MS. Estimates suggest that 350,000 people in Europe and 400,000 in the USA suffer from MS. It is the most common neurological disease in young adults, affecting twice as many women as men. In both the northern and southern hemispheres, the incidence of MS increases as you move from the Equator to the poles. Thus, MS is common in northern Europe but rare in Japan and other countries in Asia.

MS – Impaired transmission of nerve impulses

Although the actual causes of the disease remain unclear, it is well known that MS can be traced to an autoimmune reaction which is directed against the body’s own structures in the central nervous system. This destroys the myelin sheaths surrounding and protecting the nerve fibers – with severe results. The transmission of nerve impulses is impaired, causing various symptoms, e.g. vision impairment, spasticity, paresthesia, speech-related problems and even cognitive decline.

Urgent need for early diagnosis

Most patients suffer from the relapsing-remitting form of MS, in which symptoms occur suddenly, last for days, weeks or even months, and then completely or partially disappear. Some of these patients never experience another relapse. In 80 percent of all cases, however, the disease advances with worsening symptoms between individual relapses.

People with relapsing-remitting MS may shift to a chronic progressive course of MS, in which symptoms are constant, do not improve, and may get progressively worse. This form of the disease is termed secondary progressive MS. Another 10 to 15 percent of people experience what is called primary progressive MS, in which the disease advances steadily from its onset, without remission.

Diagnosis of clinically definite relapsing-remitting MS usually requires two episodes of neurological symptoms referable to the central nervous system. For patients, this can mean a long period of uncertainty about their exact condition. "In the beginning I had double vision. Two years later I became paralyzed on one side. It was only then that I was diagnosed as having MS,” says Marion Husterer, an MS patient from Germany. Modern imaging techniques, such as magnetic resonance imaging (MRI), however, have already proved very helpful in providing an early diagnosis of MS soon after the first suggestive signs arise.

Magnetic resonance imaging – Important for the early diagnosis of MS

MRI not only helps exclude alternative diagnoses, such as stroke, emotional disorders, Lyme disease, chronic fatigue syndrome, fibromyalgia, and other autoimmune disorders, it can also reveal typical MS lesions in the brain. Moreover, MR lesions are also found in the majority of patients who have had a first attack indicating their risk of developing clinically definite MS.

This discovery led to a revision of the McDonald MS Diagnostic Criteria in 2005. The revised criteria allow the use of MRI to establish a diagnosis even in the absence of clinical symptoms indicating a second MS attack. A second MRI is sufficient to make the diagnosis; it is compared with a reference MRI obtained at least 30 days after the onset of symptoms demonstrating an additional MRI lesion compatible with MS. Alternatively, dissemination of the disease in time can be established by the detection of a contrast-enhancing lesion at least 3 months after the initial clinical event.

Fig. 2: Legend: MRI brain scan with typical MS lesions (red arrows).
(Courtesy of Dr. F. Ahlhelm, Dr. G. Schulte-Altedorneburg, Department of Diagnostic and Interventional Neuroradiology, University of Saarland, Homburg, Germany)

Contrast agents show areas of acute inflammation in MS

Lesions that appear on a contrast-enhanced MR image indicate that the MS disease process is currently active. This MRI technique uses a gadolinium-based MRI contrast agent that is injected into the vein about 5 to 20 minutes before the image is taken. In areas where there is a breakdown of the blood-brain barrier, the contrast agent will appear as a bright spot on an MR image.

Bayer HealthCare Pharmaceuticals has long-standing experience in the development of MRI contrast media. The company brought the first MRI contrast medium onto the market in 1988. Today, innovative high-dose MRI contrast agents are particularly helpful in the diagnosis of diseases affecting the central nervous system, including MS.

Treatment options – Immune-modulating therapies

“Being diagnosed as having MS was a complete nightmare for me. I burst into tears and all I could see in front of me was a wheel chair,“ says Marion Husterer. But although multiple sclerosis is still incurable, there are drugs that can slow the progression of the disease. The discovery of interferons represents one of the most important therapeutic advances in the treatment of relapsing-remitting MS. In many cases these drugs can help to modulate the body’s immune system to reduce the number of MS episodes and minimize the damage to healthy nerve cells. Interferon-beta was first launched in 1993 in the USA by Berlex, a subsidiary of the former Schering AG, which is now part of Bayer HealthCare Pharmaceuticals.

Meanwhile, study results have provided evidence supporting the importance of starting MS therapy early. They show that if treatment with immune-modulating drugs is initiated soon after the first episode of MS, this can significantly reduce the risk of developing clinically confirmed MS. Results also demonstrated that patients with early treatment had significantly less cognitive impairment compared to patients receiving a delayed treatment starting after the second clinical event. Early treatment was also shown to delay the development of newly active brain lesions.

Hope and help for patients with MS

“The advice I can give to patients who are diagnosed with multiple sclerosis is to start with the medication as soon as possible. It will improve their quality of life,” says Wendy Verbruggen, a Dutch MS patient. MRI is an important tool that helps diagnose the disease at an early stage and guide therapy.