A new test that can detect iron levels in different parts of the brain may revolutionize how multiple sclerosis is diagnosed and treated.
The test is called quantitative susceptibility mapping, a type of MRI scan that looks at many areas of the brain and measures how much iron is present in each.
According to researchers, iron levels in certain areas of the brain are linked to disease duration and disability, as well as how MS progresses.
Though he’s not associated with the most recent study, Dr. Zongqi Xia, PhD, assistant professor of neurology and biomedical informatics at Pittsburgh Institute for Neurodegenerative Diseases, is hopeful of the new findings.
“Besides allowing both earlier and more aggressive intervention, early detection can provide more opportunity to test new therapies that could significantly improve quality of life,” he said.
How it works
The way the new test works isn’t simply a matter of finding which areas of the brain have the most iron.
For example, the study revealed that in a part of the brain called the thalamus — which is responsible for functions that include motor signals, sleep, and consciousness — low iron levels meant the disease would progress more rapidly.
Dr. Jack Burks, chief medical consultant for the Multiple Sclerosis Association of America, believes the new technology may open the door for a better way to quantify these iron levels to increase our understanding of the disease process.
“If researchers can associate increases in iron dysregulation as part of MS disease progression, it may help investigators to understand more about what’s causing the disease,” Burks said.
Measuring brain atrophy (shrinkage) is currently the best way to predict mental and physical decline from MS.
However, brain atrophy can take a long time to detect.
“We need better ways,” said Dr. Edward Gettings, DO, assistant professor of neurology at the Lewis Katz School of Medicine at Temple University. “But more research is required before this type of technique can be used to help in clinical decision-making.”
Burks sees potential in this new technique.
“With 15 FDA-approved disease-modifying therapies (DMTs) for MS,” said Burks, “An MRI marker of advancing disease progression would be invaluable in the DMT selection process.”
MS affects women more often
MS happens when the body’s immune system begins attacking the insulating sheath myelin of every nerve, also known as myelin, disrupting the flow of information within the brain and to the body. It can progress unpredictably and is two to three times more common in women than men.
“We still don’t know exactly why this is the case,” Xia admitted.
However, Gettings theorized reasons “may include hormonal changes due to a decrease in the average number of pregnancies, later first pregnancy, or even increasing rates of obesity.”
There may also be another factor to consider.
According to Burks, researchers at Washington University School of Medicine recently discovered “a protein which controls the immune cells’ ability to enter the brain and cause MS damage, is produced more by women than men.”
Four types of MS
There are four types of MS and each is named according to the way they affect a person over time.
- Relapsing-remitting MS (RRMS). This is the most common form of MS. Over 80 percentof people with MS are diagnosed with RRMS. People living with RRMS experience temporary relapses, which are flare-ups or periods when new symptoms appear.
- Secondary-progressive MS (SPMS). The symptoms of SPMS worsen regularly. There may or may not be relapses and remissions. Most people with RRMS will eventually progress to SPMS.
- Primary-progressive MS (PPMS). This type isn’t often diagnosed. It only occurs in about 10 percent of MS patients. People with this type of MS have slowly worsening symptoms, with no relapses or remissions.
- Progressive-relapsing MS (PRMS). This is the rarest type of MS, and only affects about 5 percent of MS patients. PRMS steadily worsens from the beginning, with occasional relapses, but no remissions.
Symptoms of MS
MS can affect many areas of the brain and cause a variety of symptoms. According to Burks, those symptoms may begin long before diagnosis. “Visits to healthcare facilities were significantly increased for MS patients compared to the patients without MS. Therefore, it appears that MS may begin years before diagnosis.”
He said early symptoms can include decreased vision, numbness, weakness, balance trouble, bowel and bladder symptoms, as well as pain.
“Almost any neurological symptom may be associated with MS,” he explained.
MS risk can be reduced
While there’s no cure for MS, there are strategies that may reduce the chances of developing this disabling condition, such as eating a healthy diet.
According to Xia, “Vitamin D deficiency has been associated with an increased risk for MS, as has smoking. Even the health of our gut bacteria has been found to influence the risk for developing MS.”
He adds, “However, based on what’s currently known about MS, it can’t be prevented.”