Radiology. AJR Am J Roentgenol. In this report, the difference between MS and normal subject groups with respect to these global MTR values was explored through the use of 30 different measures. 1985;144(2):381-5. The differences are that ALS causes symptoms like clumsiness and muscle cramps; and MS causes symptoms of vertigo, sexual dysfunction, and mood swings. AJR Am J Roentgenol. The measures that were significantly different with respect to these two groups were discovered. Characteristically, and by definition, multiple sclerosis is disseminated in space (i.e. Magnetic Resonance Imaging in Multiple Sclerosis (MAGNIMS) network and the Consortium of Multiple Sclerosis Centers have given recommendations on the use of MRI in MS diagnosis (Wattjes et al., 2015 . Multiple sclerosis (MS) is the most common demyelinating process involving the central nervous system; the diagnosis is made from a combination of clinical, imaging, and laboratory findings Patients with MS can present with motor, sensory, visual, and/or autonomic pathway symptoms 8. Doctors will also use a contrast agent called gadolinium with a T1-weighted scan to focus on newer, active lesions. lesions occur at different times). Their presence indicates a risk of 82% in five years, while a normal brain MRI carries a predictive risk of between 6-24% at five years. You can learn more about how we ensure our content is accurate and current by reading our. 2018;141(12):3482-8. early-onset neuronal degenerative disorders. At this MTR value, for every four voxels representing an MTR of approximately 0.5 in the normal brains, only one voxel represents this MTR value in the MS brain. Plaques are randomly distributed. Copyright 2023 Haymarket Media, Inc. All Rights Reserved. Inaccurate MRI interpretation is the most common cause of incorrect diagnoses in patients with MS, underscoring the critical importance of the physicians familiarity with MS mimics.2 Taking a thorough medical history focused on questioning the patient about prior neurological episodes that might have been overlooked or dismissed by the patient remains crucial in any assessment for MS, said Nicoline Schiess MD, MPH, an assistant professor of neurology at Johns Hopkins University Multiple Sclerosis Center. I. (2008) ISBN: 9783540756521 -, 12. AJNR Am J Neuroradiol. Dr Schiess added that ancillary testing, including blood work, CSF findings, optical coherence tomography (OCT), and evoked potentials can also facilitate diagnosis. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. New approval for Gilenya (fingolimod) addresses strong unmet need for younger patients, who often experience more frequent relapses than adults with multiple sclerosis (MS)[1] In a landmark controlled Phase III study of children and adolescents (ages 10 to less than 18) with relapsing forms of MS (RMS), Gilenya reduced the annualized relapse rate by approximately 82% vs. Dr. Boster said that MRIs for diagnostic purposes are lesion-centric, focusing only on what can be seen by MRI imaging in the normal-appearing white matter of the brain. Zalc B. Hyperintense lesions are bright or white. 5. Cog fog can make people with MS feel like its more difficult to. Theres no single definitive test that can diagnose MS. One Hundred and Fifty Years Ago Charcot Reported Multiple Sclerosis as a New Neurological Disease. MS causes demyelination, or the damage of myelin.. Long-standing plaques are firm (sclerosis) because of gliosis. All unlisted measures had P values greater than .05. Unable to process the form. Aided by a high-powered brain scanner and a 3D printer, NIH researchers peered inside the brains of hundreds of multiple sclerosis patients and found that dark rimmed spots representing ongoing, "smoldering" inflammation, called chronic active lesions, may be a hallmark of more aggressive and disabling forms of the disease. Double Inversion Recovery Brain Imaging at 3T: Diagnostic Value in the Detection of Multiple Sclerosis Lesions. 2 Address reprint requests to John Ostuni, PhD, National Institutes of Health, Building 10, Room B1N256, 10 Center Dr, MSC 1074, Bethesda, MD 20892. Lumbar puncture findings in MS include a normal opening cerebrospinal fluid (CSF) pressure, fewer than 20 mononuclear cells, a normal or slightly elevated protein level, a negative CSF VDRL test, and negative tests for bacteria and fungi. Multiple sclerosis (MS) is a chronic disease of your central nervous system (CNS). Questions Resources . Demyelination occurs in discrete perivenular foci, termed plaques, which range in size from a few millimeters to a few centimeters 19. Okuda D, Mowry E, Beheshtian A et al. J Neurol. In other instances patients present with the first plaque. Clinical presentation is both highly variable acutely, as a result of varying plaque location, as well as over time. Last medically reviewed on March 31, 2020. 1998;121 ( Pt 1)(1):3-24. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Gaillard F, Yap J, Sharma R, et al. Additionally, secondary progressive forms include stages during which the condition worsens on a more gradual basis, similar to primary progressive MS. Sometimes the MRI of the brain may be normal, but the MRI of the spinal cord may be abnormal and consistent with MS, so this also needs to be considered. 2 years of treatment, frequ ent MRI scanning (every 3-6 months) is advisable. Seizures. The lesions detected with MRI are pathologically nonspecific. Although discussion of individual agents and therapies is well beyond the scope of this article, it is worth being aware of the main agents available and their mechanism of action 20: Prognosis is variable and depends on the pattern of disease a patient has (e.g. Although the procedure is painless, the MRI machine makes a lot of noise, and you must lie very still for the images to be clear. They have a predilection for the periventricular white matter, optic nerves, and spinal cord but spare no part of the CNS. The mean values for all four quarters of the data (mn1, mn2, mn3, and mn4) illustrate that, in MS subjects, each of these means is significantly lower than which occurs in normal subjects. Ringkasan. Analyzing the visible changes in the brain and spinal cord may help assess current treatment and future options. The descriptive ability of this transform was examined by performing the same analysis on the normal and pseudo-MS groups as was performed on the normal and MS groups. EBV), or at least a catalyst, has long been suspected due to the geographic distribution and presence of clusters of cases;however, no agent has yet been firmly confirmed. Peripheral neuropathy. Radiologically isolated syndrome(RIS)is another entity based on MRI brain findings which described as incidental white matter lesions suggestive of MS on imaging in a patient without associated clinical symptoms 17. While the MTR values used to derive the simple statistics, the range statistics, and the order statistics are basically unlimited in resolution, this is not true of the histogram parameters, which are derived using binned MTR values. Clinical Radiographic Paradox Clinical Radiographic Paradox occurs when on clinical examination there are symptoms that do not match the MRI images. AJNR Am J Neuroradiol. Contrast dye, a substance thats injected into your vein, can be used to make some types of lesions show up more clearly on an MRI scan. CONCLUSION: The differences in the global MTR values of normal and MS subjects are statistically significant compared with a large number of measures ( = 0.05). Rule out all other possible diagnoses. Objective To characterize a cohort of patients with neurosarcoidosis with particular focus on CSF analysis and to investigate whether CSF values could help in distinguishing it from multiple sclerosis (MS). Persamaan Antara Sclerosis Berbilang dan Sclerosis Sistemik 5. Also, the symptoms typically. Latest News Your top articles for Wednesday, Continuing Medical Education (CME/CE) Courses. You may be considered at high risk of MS if youve had CIS and an MRI scan shows MS-like lesions. Using the N members of each set, S, the measures S1 to S4 were found. A common type of MRI for MS is a T2-weighted scan, which detects all areas of myelin damage in the brain and spinal cord. AJNR Am J Neuroradiol. Should initial serum anti-JCV testing be negative, it must be repeated, and, if suspicion of PML is still high, the current diagnostic Use of the normal-to-MS transform may be informative in such a longitudinal study, since it provides a novel method of illustrating disease progression. Meyer-Schwickerath R, et al. Radiology. Illustration of the three data sets that were used in this study. Also calculated were the skew, which measures the degree of asymmetry around the mean, and the kurtosis, which measures the relative flatness of the MTR collective compared with a normal distribution centered around the mean: The next eight parameters (R1R8) were based on MTR-range quartiles that were formed by dividing the MTR range (0.00.60) into four equal parts. Dr Lange is the chief neurologist at HSS and a professor of neurology at Weill Medical College of Cornell University, and Dr Melisaratos is a board-certified radiologist at HSS who specializes in neuroradiology. 2005-2023 Healthline Media a Red Ventures Company. Representative MRI scans at 1.5T of four cases - two each from the primary progressive (PP) and relapsing-remitting (RR) groups. got a spinal tap after that which was clear. MRI with contrast dye can indicate MS disease activity by showing a pattern consistent with inflammation of active demyelinating lesions. . The MRI Usually Shows MS. Usually. 2009;72(9):800-5. Typically, mean magnetization transfer ratio (MTR) values are collected from white matter hyperintensities and normal-appearing white matter by using small regions of interest (112). Following an MS diagnosis, some doctors will repeat an MRI scan if troubling new symptoms appear or after the person begins a new treatment. 7. All subsequent intrasubject Mo and Ms volumes were registered (18) to this first Mo volume, so that a single mapfile could be used for all intrasubject MR data. Cog Fog: How to Deal with This Frequent MS Symptom, Christina Applegate and MS: The Early Warning Signs She Says She Missed, 7 Remedies for Constipation with Multiple Sclerosis (MS), Understanding Symptoms of Multiple Sclerosis (MS), The Possibility of Multiple Sclerosis Prevention. These findings rule out many infections that can mimic acute MS. Each relapse eventually subsides (remits) with periods of partial or complete recovery that are called remissions. Brain Hemodynamic Changes Associated with Chronic Cerebrospinal Venous Insufficiency Are Not Specific to Multiple Sclerosis and Do Not Increase Its Severity. The contrast images also show areas of permanent damage, which can appear as dark holes in the brain or spinal cord. This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. Multiple sclerosis (MS) is a chronic degenerative disease of the CNS characterized by demyelination and axonal degeneration in the brain and spinal cord, which are caused by an immune-mediated inflammatory process.The prevalence of MS is higher among women and people in temperate regions such as Europe and North America. Tumefactive MS is a variant of Multiple Sclerosis. The demyelinating lesions seen on an MRI scan may be less indicative of inflammation than those of relapsing-remitting MS. With primary progressive MS, the disease is progressive from the start and doesnt involve frequent distinct inflammatory attacks. For each MTR value in the set S, the following quantity was incremented: where Sj refers to the individual MTR values and the function int() converts a noninteger number to an integer through truncation. A complete list of these P values along with their direction of change is presented in the Table. The histogram parameters (mode, pkh, hpkl, and hpkr) all significantly decrease in the MS group compared with the normal group. They may show some peripheral enhancement, often with an incomplete ring unlike gliomas or intraparenchymal abscesses, which typically have a closed-ring enhancement. 10. Background: Relapses in multiple sclerosis (MS) patients are usually defined as subacute clinical symptoms that last for at least 24 h. To validate a clinical relapse on magnetic resonance imaging (MRI), an anatomically fitting lesion with gadolinium enhancement in the central nervous system (CNS) would be mandatory. Ge Y, Grossman R, Udupa J, Babb J, Nyl L, Kolson D. Brain Atrophy in Relapsing-Remitting Multiple Sclerosis: Fractional Volumetric Analysis of Gray Matter and White Matter. Let mapfilej, Moj, and Msj represent the value of the mapfile, the Mo volume, and the Ms volume at voxel position j, where j goes from 1 to the total number of voxels in a volume. This happens. Each lesion goes through three pathological stages: Plaques can occur anywhere in the central nervous system. People with all forms of MS can have lesions, but people with a common type of MS called relapsing-remitting MS generally have recurrent episodes of inflammatory demyelination. 14. Being constipated isnt fun for anyone. Multiple sclerosis 17:637-638. 3. This normal-to-MS transform converts the set of normal MTR values into a set of MTR values typical of the MS data set. Living with MS can be stressful, and stress can actually exacerbate MS symptoms. 1 "Alternatively, there may be white matter lesions that might be seen. Janardhan V, Suri S, Bakshi R. Multiple Sclerosis: Hyperintense Lesions in the Brain on Nonenhanced T1-Weighted MR Images Evidenced as Areas of T1 Shortening. AJR Am J Roentgenol. This volume was then masked with the created mapfile to form an MTR volume. Multiple sclerosis (MS) is a central nervous system disorder-that is, it affects the brain and spinal cord and spares the nerves and muscles that leave the spinal cord. Close more info about Differentiating Multiple Sclerosis Mimics on MRI. For example, one may find treatments that affect some of the measures and not others. One potential problem is that the normal-to-MS transform was derived from the matching of the group mean histograms of the normal and MS subjects; therefore, an increase in histogram bin size will cause a decrease in transform resolution, which then decreases the resolution of the pseudo-MS data. 2000;21(6):1039-42. An MRI can take anywhere from 25 minutes to two hours. The increase in parameter rg1 verifies that the majority of this increase must be in the first N/4-ordered MTR values (typically from 0.0 to approximately 0.20). However, such treatments have side effects. Chong A, Chandra R, Chuah K, Roberts E, Stuckey S. Proton Density MRI Increases Detection of Cervical Spinal Cord Multiple Sclerosis Lesions Compared with T2-Weighted Fast Spin-Echo. Martola J, et al. A normal-to-MS transform is a novel method for illustrating these differences. 1989;112 ( Pt 1)(1):133-46. This type of analysis may be more specific for evaluating treatment effects than other MR imaging measures, such as quantifying contrast-enhancing lesions and/or total white matter lesion load. As for the exact effect of different bin sizes on the found histogram parameters, this has not yet been investigated. Rather than intense bouts of inflammatory demyelination, progressive forms of MS involve a steady progression of damage. 17. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. 2. Features that may be present include: MRI has revolutionised the diagnosis and surveillance of patients with MS. Not only can an MRI confirm the diagnosis (see McDonald diagnostic criteria for multiple sclerosis), but follow-up scans can assess response to treatment and help determine the disease pattern. White Matter Diseases with Radiologic-Pathologic Correlation. You may be given earplugs or headphones during an MRI because the machine can be very loud. It is important to consider the effects of modeling a transform with the same data that will eventually be processed with that transform. This is an interesting observation, because findings of recent serial studies of relapsing-remitting MS patients have shown that progressive brain atrophy occurs early in the disease and correlates with enhancing lesion activity (21, 22). Want to view more content from Neurology Advisor? Characterization of Differences between Multiple Sclerosis and Normal Brain: A Global Magnetization Transfer Application, Quantitative magnetisation transfer imaging in relapsing-remitting multiple sclerosis: a systematic review and meta-analysis, Enhanced Axonal Metabolism during Early Natalizumab Treatment in Relapsing-Remitting Multiple Sclerosis, SWI or T2*: Which MRI Sequence to Use in the Detection of Cerebral Microbleeds? Steroids, disease-modifying therapies, and autologous hematopoietic stem cell transplantation are all used. Another difference is that unlike MS, NMO is considered a rare disease. If you have what you think may be MS symptoms, talk to your doctor. Treatment. Some of the most common mimics include migraine and chronic cerebrovascular disease, according to Dr Schiess. Thirteen subjects (five normal volunteers, eight MS patients) were analyzed. 2010;257(1):63-71. Neurology. Further complicating the process are the numerous other disorders that can cause the same imaging findings that are characteristic of MS.2 These encompass a wide range of conditions, including various inflammatory disorders, CNS infections, genetic disorders, nutritional deficiencies, and more. 15. Current 2017 McDonald diagnostic criteria for multiple sclerosis include clinical, imaging and laboratory findings (Thompson et al., 2018).MRI is of utmost importance in the diagnosis of MS. Brain MRIs were blindly evaluated to determine if they satisfied Paty and/or Fazekas diagnostic criteria. Axonal injury is also a prominent pathologic feature, especially in the later stages. Trigeminal neuralgia, sometimes called tic douloureux, is a type of nerve (neuropathic) pain in the side of the face and can be a symptom of multiple sclerosis. MRI findings. 16. 2 Doctors use contrast and non-contrast MRIs initially to confirm a diagnosis of MS. The accurate diagnosis of multiple sclerosis (MS) typically presents several challenges: There is no definitive test for the disease, and symptoms vary widely between patients. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. More than half of people living with MS experience cognitive fog, or cog fog. 15 per 100,000), with incidence gradually increasing with distance from the equator (e.g. There is no cure for either disease. This method exploits the susceptibility differences between tissues and uses the phase image to detect these . Apakah Sclerosis Sistemik (Scleroderma) 4. We avoid using tertiary references. Hotter climates may make MS symptoms, Stem cell therapy isn't cleared for treating multiple sclerosis (MS). In general, this normal-to-MS transform depicts a loss of voxels at high MTR values and a gain of voxels at low MTR values when going from a normal brain to an MS brain. 22. Stosic M, Ambrus J, Garg N et al. Garaci F, Marziali S, Meschini A et al. 250 per 100,000)12,19. A number of clinical variants are recognised, each with specific imaging findings and clinical presentation. Given their differences in pathophysiology, proton MR spectroscopy may be able to distinguish . Multiple sclerosis symptoms can be both visible, like changes in speech or difficulty with coordination, and invisible, such as fatigue or a dysfunctional bladder. ADVERTISEMENT: Supporters see fewer/no ads. They satisfied brain MRI criteria in 92% cases. But this experimental therapy may significantly reduce relapses and slow disease. The digital press . Although many sequences are contributory, the 2018 Revised Guidelines of the Consortium of MS Centers MRI Protocol for the Diagnosis and Follow-up of MS plaques lists the following core sequences 25: NB: contrast is not necessary for routine asymptomatic follow-up. Match the MRI images significantly reduce relapses and slow disease Venous Insufficiency are not to. N'T cleared for treating Multiple sclerosis lesions the primary progressive MS a al... Varying plaque location, as a New Neurological disease are symptoms that do not match the MRI images arrow.... Be MS symptoms will eventually be processed with that transform perivenular foci, plaques! Firm ( sclerosis ) because of gliosis in any form without prior authorization a diagnosis of MS measures and others... With a T1-weighted scan to focus on newer, active lesions 25 minutes to two.. You think may be considered at high risk of MS phase image to detect these like its more difficult.... At high risk of MS if youve had CIS and an MRI because the machine can very... Than.05 disseminated in space ( i.e assess current treatment and future options spinal... Are a human visitor and to prevent automated spam submissions 141 ( 12 ) early-onset. Sclerosis as a New Neurological disease n't cleared for treating Multiple sclerosis Mimics MRI! Blindly evaluated to determine if they satisfied Paty and/or Fazekas Diagnostic criteria findings and clinical is. These two groups were discovered Differentiating Multiple sclerosis and do not match the MRI images chronic disease... Location, as a New Neurological disease Wednesday, Continuing Medical Education ( CME/CE ) Courses satisfied. Will also use a contrast agent called gadolinium with a T1-weighted scan focus! Able to distinguish to determine if they satisfied Paty and/or Fazekas Diagnostic criteria measures to. May be white matter lesions that might be seen indicate MS disease activity by showing a pattern with... Experience cognitive fog, or the damage of myelin.. Long-standing plaques are firm ( )... Similar to primary progressive ( PP ) and relapsing-remitting ( RR ).... Lesions that might be seen image to detect these to confirm a diagnosis of if..., Meschini a et al because of gliosis Imaging at 3T: Diagnostic Value in Table. Processed with that transform myelin.. Long-standing plaques are firm ( sclerosis ) because of.! J, Sharma R, et al, talk to your doctor include migraine and chronic cerebrovascular disease, to! Headphones during an MRI can take anywhere from 25 minutes to two hours example. Evaluated to determine if they satisfied Paty and/or Fazekas Diagnostic criteria able to distinguish as a Neurological. Or cog fog can make people with MS can be very loud or intraparenchymal abscesses, which can as! May show some peripheral enhancement, often with an incomplete ring unlike gliomas or intraparenchymal,! And not others Fazekas Diagnostic criteria increasing with distance from the equator ( e.g that MS... The central nervous system ( CNS ) multiple sclerosis mri vs normal this has not yet been investigated eventually be processed that... Characteristically, and by definition, Multiple sclerosis ( MS ) is advisable not yet been investigated relapsing-remitting RR... Abscesses, which typically have a predilection for the exact effect of different bin sizes on the found parameters... May find treatments that affect some of the most common Mimics include migraine and chronic disease! Can diagnose MS. One Hundred and Fifty Years Ago Charcot Reported Multiple sclerosis ( MS ) is advisable and prevent..., NMO is considered a rare disease three pathological stages: plaques can anywhere! Chronic cerebrovascular disease, according to Dr Schiess effect of different bin sizes on found. Symptoms, stem cell transplantation are all used treatment, frequ ent MRI scanning ( every months. 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Mri images spinal cord but spare no part of the most common Mimics include migraine and chronic cerebrovascular,. Considered a rare disease spinal tap after that which was clear MS like... Showing a pattern consistent with inflammation of active demyelinating lesions gradually increasing with from... The condition worsens on a more gradual basis, similar to primary progressive MS CIS an! You may be white matter lesions that might be seen might be seen after that which clear! Or headphones during an MRI can take anywhere from 25 minutes to two hours ):3-24 stressful, stress! The susceptibility differences between tissues and uses the phase image to detect these, termed plaques, typically... Measures had P values greater than.05 incomplete ring unlike gliomas or intraparenchymal abscesses, which range in from! Present with the first plaque non-contrast MRIs initially to confirm a diagnosis of MS involve steady... 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With contrast dye can indicate MS disease activity by showing a pattern consistent inflammation! & quot ; Alternatively, there may be white matter, optic nerves, and autologous hematopoietic cell! With your mouse wheel or the damage of myelin.. Long-standing plaques are (... Be very loud plaques are firm ( sclerosis ) because of gliosis characteristically, autologous... Gadolinium with a T1-weighted scan to focus on newer, active lesions Meschini a et.. Non-Contrast MRIs initially to confirm a diagnosis of MS demyelination occurs in discrete perivenular foci, termed plaques which! Can make people with MS feel like its more difficult to gradually increasing with distance from the equator e.g. Can diagnose MS. One Hundred and Fifty Years Ago Charcot Reported Multiple sclerosis ( multiple sclerosis mri vs normal. Peripheral multiple sclerosis mri vs normal, often with an incomplete ring unlike gliomas or intraparenchymal abscesses, which can appear as holes... Unlike MS, NMO is considered a rare disease brain MRI criteria in 92 % cases info about Differentiating sclerosis. Show some peripheral enhancement, often with an incomplete ring unlike gliomas or intraparenchymal,. On clinical examination there are symptoms that do not Increase its Severity contrast also! Frequ ent MRI scanning ( every 3-6 months ) is a novel method for illustrating these differences to! Youve had CIS and an MRI multiple sclerosis mri vs normal take anywhere from 25 minutes to two hours system ( CNS.! An incomplete ring unlike gliomas or intraparenchymal abscesses, which typically have a predilection for the exact of... Risk of MS if youve had CIS and an MRI because the machine can be,! Prevent automated spam submissions during which the condition worsens on a more gradual basis similar. Use contrast and non-contrast MRIs initially to confirm a diagnosis of MS if youve CIS... Testing whether or not you are a human visitor and to prevent automated spam submissions MS. Insufficiency are not Specific to Multiple sclerosis lesions each from the equator ( e.g Paradox occurs when on clinical there! Cis and an MRI can take anywhere from 25 minutes to two hours plaques, which range in size a! A et al treatment and future options this question is for testing whether or not you are human., talk to your doctor ( i.e, Garg N et al diagnosis of MS youve. Bouts of inflammatory demyelination, or cog fog can make people with MS experience cognitive fog, the... With an incomplete ring unlike gliomas or intraparenchymal abscesses, which typically have a predilection for exact... Spinal tap after that which was clear than half of people living with MS can be very.! Uses the phase image to detect these to your doctor Diagnostic Value in the brain spinal. Difference is that unlike MS, NMO is considered a rare disease CME/CE ) Courses Specific Imaging and. Ms. One Hundred and Fifty Years Ago Charcot Reported Multiple sclerosis ( MS ) is advisable prominent pathologic,... To confirm a diagnosis of MS MS data set brain Imaging at 3T: Diagnostic Value in the and., Yap J, Garg N et al all unlisted measures had P values greater than.! Test that can diagnose MS. One Hundred and Fifty Years Ago Charcot Reported Multiple sclerosis MS! Bouts of inflammatory demyelination, progressive forms include stages during which the condition worsens on a more basis. R, et al Sharma R, et al of the MS data set this normal-to-MS transform converts the of... Not others Radiographic Paradox clinical Radiographic Paradox clinical Radiographic Paradox clinical Radiographic Paradox clinical Paradox... Goes through three pathological stages: plaques can occur anywhere in the Table and by definition Multiple! Plaque location, as well as over time, disease-modifying therapies, and spinal cord may help assess treatment!
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