Multiple Sclerosis and Variants

Abstract

In the spectrum of inflammatory demyelinating diseases (IDDs), the most common disorder is multiple sclerosis (MS). Clinical neuroradiology plays a crucial role in MS to establish the diagnosis, to provide a prognosis, and increasingly to monitor treatment efficacy and safety. Radiological techniques important in MS are MRI of the brain and spinal cord. Dissemination in time and space according to so-called McDonald criteria requires demonstration of lesions in the brain and spinal cord. In addition to the classical multiple sclerosis (MS) phenotypes, different MS variants have been described, which can be differentiated based on severity, clinical course, and lesion distribution; salient features will be discussed. Other forms of IDDs are now recognized as distinct entities and not MS variants, including acute disseminated encephalomyelitis (ADEM) and neuromyelitis optica spectrum disorders (NMOSD), and will be discussed in other chapters. Relapsing-remitting and secondary-progressive phenotypes are the most common forms of MS, and a fast lesion accrual earlier in the disease course is often found. A smaller number of patients have a progressive course from onset (primary-progressive MS) or a benign course with minimal or no disability >10–15 years after onset (benign MS). Monitoring in MS requires a standardized protocol to detect new lesions that may inform switching of disease-modifying treatments but also detect opportunistic infections such as progressive multifocal leukoencephalopathy (PML) in a preclinical stage.

This publication is endorsed by: European Society of Neuroradiology (www.esnr.org)