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From the University of Texas Southwestern Medical Center at Dallas (Drs. Frohman, Hawker, Phillips, and Racke); University of California at San Francisco (Dr. Goodin); University of Maryland (Dr. Calabresi), Baltimore; University of Colorado (Dr. Corboy), Denver; State University of New York (Dr. Coyle), Stony Brook; University of Milan (Dr. Filippi), Italy; National Institutes of Health (Dr. Frank), Bethesda, MD; University of Pennsylvania (Dr. Galetta), Philadelphia; New York University (Dr. Grossman), New York; University of Southern California (Dr. Kachuck), Los Angeles; University of Tennessee (Dr. Levin); Baylor College of Medicine (Dr. Rivera), Houston, TX; and Peachtree Neurological Clinic (Dr. Stuart), Atlanta, GA.
Address correspondence and reprint requests to Dr. Elliot M. Frohman, University of Texas Southwestern Medical School, Department of Neurology, 5323 Harry Hines Boulevard, Dallas, TX 75235-9036; e-mail: elliot.frohman{at}utsouthwestern.edu; or Wendy S. Edlund, Manager, Clinical Practice Guidelines, American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116; e-mail: wedlund@aan.com
Advancements in imaging technologies and newly evolving treatments offer the promise of more effective management strategies for MS. Until recently, confirmation of the diagnosis of MS has generally required the demonstration of clinical activity that is disseminated in both time and space. Nevertheless, with the advent of MRI techniques, occult disease activity can be demonstrated in 50 to 80% of patients at the time of the first clinical presentation. Prospective studies have shown that the presence of such lesions predicts future conversion to clinically definite (CD) MS. Indeed, in a young to middle-aged adult with a clinically isolated syndrome (CIS), once alternative diagnoses are excluded at baseline, the finding of three or more white matter lesions on a T2-weighted MRI scan (especially if one of these lesions is located in the periventricular region) is a very sensitive predictor (>80%) of the subsequent development of CDMS within the next 7 to 10 years. Moreover, the presence of two or more gadolinium (Gd)-enhancing lesions at baseline and the appearance of either new T2 lesions or new Gd enhancement on follow-up scans are also highly predictive of the subsequent development of CDMS in the near term. By contrast, normal results on MRI at the time of clinical presentation makes the future development of CDMS considerably less likely.
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