prepared for the MS community by
Buffalo Neuroimaging Analysis Center
Dejan Jakimovski, Taylor R Wicks, Niels Bergsland, Michael G Dwyer, Bianca Weinstock-Guttman, Robert Zivadinov. Published in Degenerative Neurological and Neuromuscular Disease by Dove Press in 2023
The MRI metric correlating best with MS disability: deep gray matter volume
Participant responses about their symptoms (patient-reported outcomes) on simple
questionnaires correlate closely with deep gray matter volume, current disability,
and future disease progression.
Depression is a significant factor in disease progression
Currently, MS Disability is assessed by two standards:
Physical performance testing
Clinicians traditionally measure MS disability using assessments that focus on physical, especially walking disability. The most common of these assessments has been the Expanded Disability Severity Scale (EDSS). However, EDSS scoring comes up short because of its narrow focus. For example, two people with MS may have identical EDSS scores, but report vastly different levels of fatigue, chronic pain, cognitive decline, bowel and bladder issues, and/or depression.
MRI imaging for multiple sclerosis looks mostly at the number and intensity of lesions in the brain's white matter. This is referred to as white matter lesion load. This metric also comes up short the disability people with MS experience and that which is observed in clinic does not correlate with the MRI findings. For example, someone with a high white matter lesion load may have no clinical symptoms, while someone else with low white matter lesion loads may be significantly disabled.
The paper describes two better standards for assessing and predicting MS Disability
Deep gray matter analysis
Newer MRI analyses, such as measurement of the deep gray matter volume, have recently been suggested as the best radiologic markers of MS disability. This BNAC paper concludes, as its principal finding, that patient reported outcomes correlate well with deep gray matter volume.
Patient reported outcomes
This study used a patient-reported outcome questionnaire that compiled measurements that line up with what people with MS actually experience. This tool, currently used mostly for research, could also be used by clinicians as an additional way to track MS progression.
Several papers published by the Buffalo Neuroimaging group over the past two years have shown that patient-reported outcomes are actually better at assessing patient condition and predicting future progression than more widely accepted metrics such as EDSS.
Prepared by Advisory Council Members, Carol Schumacher, Mitchell Sturgeon, Tracie Jacquemin, Patricia Picco, Marc Stecker, and Craig Walters.
Watch Advisory Council interview with
About a Better Way to Measure Progressive MS
The Buffalo Neuroimaging Analysis Center is part of the Department of Neurology Jacobs School of Medicine and Biomedical Sciences of the University at Buffalo, State University of New York at Buffalo