What are the MAGNIMS (Magnetic Resonance Imaging in MS) Network guidelines for monitoring established multiple sclerosis (MS)?

Updated: Oct 08, 2019
  • Author: Christopher Luzzio, MD; Chief Editor: Jasvinder Chawla, MD, MBA  more...
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Answer

The recommendation for monitoring of patients with established diagnosis of MS include the following:

  • T2-weighted and contrast-enhanced T1-weighted brain MRI are the modalities of choice for MS disease monitoring
  • The use of spinal cord MRI in addition to brain MRI is not recommended for routine monitoring  and should be limited to certain clinical situations (eg, unexplained and/or unexpected spinal cord symptoms)
  • Although assessment of brain volume does not have a role in the diagnosis of MS, it can be a good predictor of long-term disability
  • Rates of change in brain volume are not recommended as a marker of disease progression in individual patients, owing to the technical, biological and pharmacological factors that can influence the measurement and interpretation of atrophy rate
  • MRI should be included in drug monitoring to screen for opportunistic infections, unexpected disease activity (including paradoxical reactions), and comorbidities
  • In patients at high risk of developing opportunistic infections who are switching disease-modifying drugs (DMDs), brain MRI should be performed at the time the current treatment is discontinued and after the new treatment is started
  • Enhanced pharmacovigilance, including brain MRI every 3–4 months for up to 12 months, is required in patients who switch from natalizumab to other therapeutics (including fingolimod, alemtuzumab, and dimethyl fumarate)

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