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Review ArticleREVIEW ARTICLE
Open Access

Current and Emerging Therapies in Multiple Sclerosis: Implications for the Radiologist, Part 2—Surveillance for Treatment Complications and Disease Progression

C. McNamara, G. Sugrue, B. Murray and P.J. MacMahon
American Journal of Neuroradiology April 2017, DOI: https://doi.org/10.3174/ajnr.A5148
C. McNamara
From the Departments of Radiology (C.M., G.S., P.J.M.) and Neurology (B.M.), Mater Misericordiae University Hospital, Dublin, Ireland.
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G. Sugrue
From the Departments of Radiology (C.M., G.S., P.J.M.) and Neurology (B.M.), Mater Misericordiae University Hospital, Dublin, Ireland.
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B. Murray
From the Departments of Radiology (C.M., G.S., P.J.M.) and Neurology (B.M.), Mater Misericordiae University Hospital, Dublin, Ireland.
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P.J. MacMahon
From the Departments of Radiology (C.M., G.S., P.J.M.) and Neurology (B.M.), Mater Misericordiae University Hospital, Dublin, Ireland.
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Abstract

SUMMARY: An understanding of the new generation of MS drugs in conjunction with the key role MR imaging plays in the detection of disease progression, opportunistic infections, and drug-related adverse effects is of vital importance to the neuroradiologist. Part 1 of this review outlined the current treatment options available for MS and examined the mechanisms of action of the various medications. It also covered specific complications associated with each form of therapy. Part 2, in turn deals with the subject of pharmacovigilance and the optimal frequency of MRI monitoring for each individual patient, depending on his or her unique risk profile. Special attention is given to the diagnosing of progressive multifocal leukoencephalopathy in patients treated with natalizumab as this is a key area in which neuroradiologists can contribute to improved patient outcomes. This article also outlines the aims of treatment and reviews the possibility of “no evidence of disease activity” becoming a treatment goal with the availability of more effective therapies. Potential future areas and technologies including image subtraction, brain volume measurement and advanced imaging techniques such as double inversion recovery are also reviewed. It is anticipated that such advancements in this rapidly developing field will improve the accuracy of monitoring an individual patient's response to treatment.

Abbreviations

BV
brain volume
DIR
double inversion recovery
DMT
disease-modifying therapy
IRIS
immune reconstitution inflammatory syndrome
JC virus
John Cunningham virus
MTR
magnetization transfer ratio
NEDA
no evidence of disease activity
NTZ
natalizumab
NTZ PML
natalizumab-associated PML
PML
progressive multifocal leukoencephalopathy
PML IRIS
PML-associated IRIS
PSIR
phase-sensitive inversion recovery
  • © 2017 American Society of Neuroradiology

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Current and Emerging Therapies in Multiple Sclerosis: Implications for the Radiologist, Part 2—Surveillance for Treatment Complications and Disease Progression
C. McNamara, G. Sugrue, B. Murray, P.J. MacMahon
American Journal of Neuroradiology Apr 2017, DOI: 10.3174/ajnr.A5148

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Current and Emerging Therapies in Multiple Sclerosis: Implications for the Radiologist, Part 2—Surveillance for Treatment Complications and Disease Progression
C. McNamara, G. Sugrue, B. Murray, P.J. MacMahon
American Journal of Neuroradiology Apr 2017, DOI: 10.3174/ajnr.A5148
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