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Help With Progression

I need some help. Being direct, does anyone know if there HAS to be new lesion activity in order for there to be any progression, changes or a major flare up? I've been in the midst of a horrible, debilitating flare up for 4 months but there is no new lesion activity. The doctor is acting like I'm nuts or something now. Thanks

  1. No, there doesn't have to be. "Silent" progression can happen in the absence of MRI activity where there is "no evidence of disease activity" (NEDA).


    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518998/



    First of all, MRI can only picture the white matter, and MS known to also be a grey matter disease, it is also a disease that causes brain atrophy at significantly greater rates than healthy controls and brain atrophy is associated with disability and cognitive decline. Neuros don't like to disclose that they actually only have part of the picture when it comes to disease activity. Lesions count and load do not necessary correspond to disability either. That's why some scientists propose that brain volume loss should be a better indicator of disease activity as it has shown to directly correlate with cognitive issues some types of disability in MS. I'll see if I can find more links to add with regards to those (don't have them handy at the moment).

    1. Grey matter damage in multiple sclerosis:
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3609053/

      1. Evidence of deep grey matter involvement in post-mortem studies of the brain:
        https://jnnp.bmj.com/content/85/12/1386

        1. They knew about this 10+ years ago:
          https://pubmed.ncbi.nlm.nih.gov/18703006/

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