Does a Relapse ALWAYS Show on MRI?

[coco31]

I previously posted that I had my 3rd relapse in less than 5 months. Sensory involvment first 2 times. Came home from work last monday and my speech was slurred and by tuesday I lost the power in my legs. Had IV steriods for 3 days and a repeat MRI to see if we should switch to tysabri (currently on copaxone).

On MRI; high signal lesions in all the same places as before (in many) but a new increased signal of intensity in medulla oblongota (is this considered a new lesion?) and NO enhancing lesions..... So I qualify for tysabri without an enhancing lesion? and even though neuro said it was a definite relapse (I was probably in denial when i asked him if he was sure after examination) would relpase show on MRI....?    

All help appreciated....

Sharon

[coco31]

Thanks Girls,

I thought when I saw a fairly clear MRI result (minus the new high signal in medulla) that the doctors must have thought I was crazy and I wasn't having a relapse. I didn't even know I was relpasing until boyfriend saw slurred speech and next days couldnt lift my legs. In all fairness to my neuro (whom I think is wonderful) he did a full examination and said "I'm afraid its a relapse" even before MRI.

As for tysabri - this is my 3rd and probably worst relaspse in less than 5 months. At this point I DONT want to relapse as frequent and I'm willing to try anything. Whatever it takes! I'm so determined to get well and get on a drug thats going to be most effective but number 1 - the safest. Alot to consider............

PS: Anyone else with lesions in the medulla - from what I can see this is not particularily common in MS - but I could be wrong......

[Sarahsmom46]

This is very interesting to know. I am so happy this question was asked . It clears up much of what my neuro told me several months ago but I just didn't understand at the time,

Sharon, I don't know what you ultimate decision will be on going with Tysabri but hope that you will get the relapses under control.  I have been on copaxone for 6 months now and my doctor thinks it is not working as well as he'd hoped, but I'll stick with it awhile to be sure.

Take good care and thanks for bringing up a very good and relevant question.

Julie

[Quixotic1]

Hi, Sharon, a relapse is defined by the behavior of the symptoms NOT the appearance of the MRI.  This should always be true.  Your neuro is reading your clincial course when he calls this a relapse - and rightly so!  Godd for him!

A new signal of intensity is, indeed, a new lesion.

Beings that most people do not have enhancing lesions, even with relapses, the determination of whether you qualify for Tysabri would be made by looking at your symptom behavior, how much is improving, new appearance of symptoms, evidence from your neuro exam, accummulation of disability AND accumulation of new lesions on MRI.  That new lesion likely enhanced right at its beginning.  Enhancement may be a short-lived thing - maybe only a couple weeks to an as long as 6 weeks - rarely longer.

Quix