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Disappearing Lesions - What is the Significance in MS?
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Disappearing Lesions - What is the Significance in MS?

Dear Dr. Kantor,  

We have discussed disappearing lesions on follow-up MRIs, but I still do not understand how and why this happens in MS?  My neurologist said it can happen in MS and that's all I could get out of him.  By the way, I do not have a definite diagnosis of MS, only "possible" MS.  

My question: Say I have 7 lesions on MRIs from 7 months and 4 months ago.  In my last MRI a few weeks ago, 2 lesions "disappeared".  This disappearing act came 3 weeks after a 3-day IV Solu-Medorl and steroid taper.  Did the lesions really disappear and if so, how and why does this happen?   Can a IV-SM treatment have an effect of lesions disappearing? Are there any other neurological conditions that would have the same MRI findings? What is the significance of disappearing lesions in MS?

It has been a challenge to find anything I could truly understand on the web about this as the information was way over my head.  

Thanking you in advance for you response.

Julie
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559187_tn?1330786456
If I have posted this wrong, please steer me to where we are supposed to send these posts.  I don't see the new doctor Medhelp link anymore.  Thanks.

Julie
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Hi Julie,

Sorry, but yes, this is the wrong place.  Look on the right side of the page and scroll down until you get to, "Related Expert Forum", then click on Multiple Sclerosis.

Take care!
doni
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559187_tn?1330786456
I went back and tried to read archived posts on the disappearing lesion and found some really good posts.  One questions remains, really, only one and if anyone can find info on it I'd be very grateful.

Can a course of IV steroid treatment have an effect on a subsequent MRI regarding having lesions disappear?  I am stunned to hear that 2 lesions they saw 4 months ago are now gone, 5 are still there, but it was interesting to hear what happened to the other 2.  I was just wondering if my recent steroid treatment had an effect on this or am I just having false hope.  

Thanks you guys are so smart and helpful.

Julie
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559187_tn?1330786456
I'm about to give up on finding an answer for these questions.  The internet is so cruel sometimes or maybe medical science doesn't really have an answer.  What is even more elusive to me is trying to figure out how people are getting their questions on the Ask Dr. Kantor without paying the $25.  Now, that is the real question. LOL!  

Anyway, I'll bump this up and if we still can't find someone brilliant out there to answer then I give up.  

Julie
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147426_tn?1317269232
Hold onto your $25 for now.  I can help at little.

First, yes, lesions can disappear form the MRI in MS, and it happens all the time.  I describe how it occurs in the first Health Page, "How MRIs Show Lesions in MS."  In brief, a lesion (a T2 hyperintense white matter lesion) first demyelinates and shows up on the MRI for as long as it is in the damaged state.  The body tries to repair the damaged myelin (fatty coating around the nerve).  The attempt at remyelinating is often quite successful and the lesion may disappear from the MRI.  

In reality remyelination is not perfect in healing the nerve, so the nerve signals in the repaired nerves are usually still slowed.  The symptom that lesion may have caused may go away, but may reappear when the nerve is stressed - like with getting overheated (remember the hottub incident?) or with fatigue.

This remyelination is why people with classic, milder RRMS can have a relapse and then apparently return completely to normal during their remissions.  Even people with more severe disease still have some lesions that disappear.  So disappearing lesions are quite normal in MS.  Lesions come and lesions go - but mostly they come.

About the resolution of lesions with Solumedrol.  The answer is that solumedrol does not heal lesions.  If it did they could treat MS with steroids alone.  What the steroids do is relieve any inflammation that may be causing acute symptoms.  Ideally you would think that all lesions with new inflammation will "enhance" on MRI, but if the inflammation is minor/small, they might not be seen as enhancing.  Your lesions disappeared 3 weeks after the steroids.  In general this is too long a time to say that the Solumedrol is responsible for the disappearance.  Steroids take effect within 24 hours and do their thing pretty quickly.  If you felt better during and after the IV steroids then we can safely say that some of the inflammation around lesions was helped by the med.

Does all this make sense?  Also please read the HP, too.

About getting a message into Dr. Kantor.  This is the way it works.  The Expert Forums allow 1 or 2 questions a day.  Once the limit has been reached for the day, we get the notice that no more questions are being taken for that date.  Or, in Dr. Kantor's case, no more free questions are being taken.  MedHelp juggles the "open period" each day so that people in different time zones have equal access to getting a question asked.  So we never know when the forum is open for its question.  You just have to check over and over and at different times of the day and night.  I have NEVER been successful in getting a question in to ANY forum, so I appearently never check at the right time.

I can't believe no one is talking MS to you.  What IS your doctor saying?

Hope this helps,

Quix
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Q- Julie is just about to get her DX from the NIH folks - she is seeing them at home in Maryland and has bunches of appts. this month.  

Julie- I trust that definitive answer from our very own expert is worth at least $25!  :-)  

My best, Lulu
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559187_tn?1330786456
Thanks for the response Quix.  I did read the HP over and over and now this is starting to make sense.  Still a quick question or two.

1.  Are the lesions that apparently disappeared really gone-gone or just smaller or hiding in there still?

2. Are there any other neuological conditions that you know of that have disappearing lesions like that found with MS lesions?  

I still have several other lesions that are still there, only the 2 disappeared.  

In response to what the docs are saying right now, well as Lu said the NIH is helping with this dx and I am waiting until all the tests are completed to see what their consensus is.  They are repeating many of the tests that have already been done last May because they want to be sure nothing is being missed.  The NIH neuro said that my lesions are not in the "normal" places, but that they are suspicious.  Also that my other test findings don't scream "MS", but again they are suspicious.  I was ready to hear him tell me they didn't need me in the study when he mentioned that at thei tema meeting last week, they were all in consensus to keep me in the study and pursue the dx.  I am fortunate for that and hope by end of February when all is said and done that we know where this dx is going.  I'll keep you guys informed if you are interested.  

Thanks again for taking your time to help me with all these questions.  I was so helpful to me and some others I am talking offline with about the vanixhing lesions.  

Hope you have a good day today.

Julie
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Quix,

I am so glad you are back!!

Hugs,
doni
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198419_tn?1360245956
OH MY!

This is GREAT, Quix!  Thank you for bringing up the question like this Julie because it prompted this amazing response!  Though you do touch on this in your mri/lesion HP -- can I, please, please, pretty please make this an HP on it's own? I'll put Sarah's question in there and the example she provides, then your response, etc?

I've not understood this process as well as I feel I do now w/this new addt. interp.

Waiting patiently (well, not so much ha/ha)
Shell

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559187_tn?1330786456
That would be a great HP Shell.  I had to dig around the HP done on lesions, which was great, to glean info on the disappearing lesions.  

So, I'm bumping this up so Quix can see Shell's offer to do an exclusive HP on this issue.  

Quix, please let us know if you think this is doable.  

-Julie (AKA Sarahsmom46)
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147426_tn?1317269232
Gollleee, guys.  I didn't realize that pearls were dropping off my fingertips, lol.

To answer questions:

>>1.  Are the lesions that apparently disappeared really gone-gone or just smaller or hiding in there still? <>2. Are there any other neurological conditions that you know of that have disappearing lesions like that found with MS lesions? <<

Many other disorders can have lesions that heal.  These include the autoimmune disorders, infections, demyelinating disorders like ADEM (Where is Santana, anyway??) and others.  However, I think that the pattern of appearing and disappearing lesions is a strong pointer toward MS.  

Not all people with MS will have lesions disappear.  Also, not all lesions any of us have will eventually disappear.  Some are too badly damaged and cannot be remyelinated.

***************
About the HP.  Silly Rabbits.  The Health Pages belong to all of us, and ANY of us who feel so moved may write one up.  They do NOT need to be approved by me.  I'm flattered that you want to do one from what I wrote.  Please do it.

You're all so sweet!

Quix
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Hmmm, my answer to Julie's questions got scrambled!  The first question's answer got completely disappeared, not unlike her lesions.

>>1.  Are the lesions that apparently disappeared really gone-gone or just smaller or hiding in there still? <<

There is no way of telling what truly has happened.  The lesions may have shrunk so that they are no longer visible to the MRI machine, but maybe could be seen by a more powerful MRI machine.  OR they may have healed so well that the area of the lesion now looks just like normal-appearing white matter.  Within the same person both things could be happening with different lesions.

Remember, though, that when the brain repairs damaged myelin the repair is not perfect.  Though the nerves may look okay, they typically still transmit their signals more slowly than they did before the damage.  This slowness may show up as the reappearance of old symptoms when a person gets overheated.

A good example of this is when a bout of optic neuritis heals.  Optic neuritis is caused by a lesion of demyelination on the optic nerve.  The lesion may remyelinate and the visual symptoms will go away.  Any lesion that was seen on the MRI will also disappear.  However, when you do a VEP (Visual Evoked Potential) on that person, the result will still be abnormally slow.  Remember the VEP measures the speed of the visual signal along the optic nerve and then to the visual center of the brain.  After optic neuritis you typically find the nerve signal remains slowed even after healing.

I think this is what I wrote.  I wonder where that part of the answer went?  I suppose it is off floating around the internet, someday to magically land on a computer and mystify the h ell out of someone.

Quix
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147426_tn?1317269232
Julie got her question in to Dr. Kantor.

His answer was identical to mine, just expressed much more simply and much more clearly.

He said that we expect MS to be "dynamic."  So we expect to see an increase and decrease in lesions.

He also said that lesions can disappear because a "combination of healing scars and resolution of the MRI."

Quix
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Hi,
I am totally new to this forum...I found it by seeking answers for my own "disappearing lesions/plaques".  I went for yet another MRI a few months ago.  My neurologist read my results, starting with the lower spine on up.  At each spinal section, he said, "No lesions there."  Before he started on my brain (where there WERE two new "hot spots"), I asked him how the old spinal lesions were.  He said, "What lesions?"  There were NONE there.  He had to pull out my old MRI images to verify that I had even had prior spinal lesions!  Then I was told that it was "extremely rare," but occasionally this happens--more so in the brain than the spine.  What this means, I am not sure.  I am not even sure this is something to be happy about...hmmmmm.  Thoughts, anyone?  I am currently managing my MS without drugs, as I have had some pretty harsh drug reactions...
Shelley
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198419_tn?1360245956
  Hi there,

Welcome to the forum.  Were you on on a DMD ever? It's actually not rare for lesions to heal, they can, and do sometimes.   Do you know if the strength of the MRI was the same as last time?

You popped in on a great discussion from earlier in the year and it was used to create this health page:

http://www.medhelp.org/health_pages/Multiple%20Sclerosis/Lesions---Can-they-Disappear-A-Hypothetical-Case-Overview/show/566?cid=36

When the Dr. says hot spots - was he/she referring to lesions?  If you are able, copy and paste your post using the green 'post a question' button - so we can all say hello, welcome you properly, and provide thoughts.

-shell
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Welcome to the forum! Like Shell says, you might want to post a new question so more people will see it, but FWIW I did partially have an experience like yours. I had a cervical spine MRI in 2007 that showed three lesions, which sounded to me like they were pretty good-sized (longest was an inch). I had a follow-up MRI maybe 15 months later that described more, smaller lesions and said some had improved or disappeared.

As to what this means, I don't know. In my case, I was far worse off at the time of the second MRI and supposedly most of my symptoms (and lesions--my brain apparently just has a smattering of spots) are spinal ones.

Not sure what good it does if the MRI gets better, but *I* don't. Although MRIs are important, I think some neuros over-rely on them despite the fact that they don't show everything and don't particular correlate with clinical progression.

sho
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What does this Mean

Had MRI done results were stable spine alignment with mild left curvature at thoracolumbar junction. Lateral spine alignment adequate. Vertebral body heights preserved and vertebral marrow signal within normal limits....Congerital spinal dysraphism again noted at s1
Conus terminates appropriately at L1 spinal cord caliber within normal limits. Unremarkable craniocervical junction . At anterior left paracentral aspect of the spinal cord  , at mid c2 level thereis a questionable round 2 mm t2 hyperintense lesion visualized in axial plane  similar appearing 2mm left paracentral lesion visualized within spinal cord at the t 12 level axial plane  questionable spial corc lesions c2 and t 12 is the conclusions
What does this all mean
Does it mean I have MS
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Welcome Jenny you might want to start a new post. Just click on Post question. You can copy and paste this.

Alex
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