Follow-up Of Multiple Sclerosis Research Articles

Apparent Diffusion Coefficient in the Diagnosis and Follow-up of Multiple Sclerosis: Role of Magnetic Resonance Imaging

Background: Chronic Multiple Sclerosis (MS) modifies the apparent diffusion coefficient (ADC) value due to severe pathological changes. After trauma, it is the second most common cause of brain injury in healthy young adults. MRI is considered the initial imaging modality for MS diagnosis and follow-up. Objective: To assess the significance of the ADC in the diagnosis and follow-up of MS plaques across various disease subtypes. Methods: Forty MS patients were included in a case-control study at Ibn-Sina Teaching Hospital, Mosul Province, between June 1, 2022 and February 28, 2023. The patients had diffusion-weighted and traditional MR imaging with ADC measurement in plaques, and the normal white matter value of controls was compared to the patients' results. Results: The ADC values were higher in cases that were acute or secondary-progressive than in relapsing-remitting cases or normal white matter. In both types of newly generated plaques, there was an initial non-significant increase in ADC values compared to existing plaques. Overall, the ADC sensitivity, specificity, and accuracy in diagnosing MS were 85.7%, 95.2%, and 90.5% in acute cases, and 85.7%, 83.3%, and 84.6% in chronic cases, respectively, with no significant difference between active and inactive lesions. Conclusions: The apparent diffusion coefficient value can be included in the imaging protocol for the diagnosis and follow-up of various subtypes of MS.

Advanced MRI Techniques: Diagnosis and Follow-Up of Multiple Sclerosis.

Brain and spinal cord imaging plays a pivotal role in aiding clinicians with the diagnosis and monitoring of multiple sclerosis. Nevertheless, the significance of magnetic resonance imaging in MS extends beyond its clinical utility. Advanced imaging modalities have facilitated the in vivo detection of various components of MS pathogenesis, and, in recent years, MRI biomarkers have been utilized to assess the response of patients with relapsing-remitting MS to the available treatments. Similarly, MRI indicators of neurodegeneration demonstrate potential as primary and secondary endpoints in clinical trials targeting progressive phenotypes. This review aims to provide an overview of the latest advancements in brain and spinal cord neuroimaging in MS.

Longitudinal Changes of Functional Connectivity Dynamism Are Relevant for Disability Worsening in Multiple Sclerosis: A 2.5-Year Study (P10-3.018)

<h3>Objective:</h3> To investigate changes in time-varying functional connectivity (TVFC) over 2.5 years of follow-up in multiple sclerosis (MS) patients and their association with disability progression. <h3>Background:</h3> In MS patients, TVFC analysis showed abnormalities of the main functional networks, correlated with more severe clinical and cognitive disability. Preliminary evidence showed that MS-related cognitive decline was associated with progressive TVFC destabilization. However, the clinical relevance of longitudinal TVFC changes has not been investigated yet. <h3>Design/Methods:</h3> 3T-MRI scans and clinical evaluations were obtained at baseline and at median follow-up of 2.5 years from 129 right-handed MS patients (103 relapsing-remitting [RR] and 26 progressive [P]) and 28 matched healthy controls (HC). At 2.5-year follow-up, patients were classified as clinically stable/worsened according to their disability change. TVFC was quantified at voxel-wise level as the coefficient of variation (CoV) across sliding-windows of degree centrality. <h3>Results:</h3> At follow-up, 25/129 (19.3%) MS patients worsened clinically. At baseline, MS patients showed reduced TVFC <i>vs</i> HC in the bilateral orbitofrontal cortex (p&lt;0.05, family-wise error corrected), left cerebellum, right precuneus and left thalamus. At 2.5-year follow-up, a widespread reduction of TVFC over time (p&lt;0.05, family-wise error corrected) was found in MS patients in temporal, parietal, occipital and frontal lobes, as well as in the cerebellum. Such a pattern of TVFC reduction was also found when looking at clinically stable MS patients. Clinically worsened MS presented peculiar TVFC reductions in areas of the default-mode network and basal ganglia. Reduced TVFC in the left putamen in clinically worsened <i>vs</i> stable MS patients was significant at time <i>x</i> group interaction analysis. <h3>Conclusions:</h3> After 2.5 years of follow-up, MS patients showed widespread TVFC reduction in cortical lobes and cerebellum. A peculiar involvement of deep grey matter was found in clinically worsened MS patients. Accrual of TVFC abnormalities in deep grey matter regions may represent a biological substrate of disability worsening. <b>Disclosure:</b> Dr. D’Amore has nothing to disclose. Paola Valsasina has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for ACCMED. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bristol Myers Squibb . Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Sanofi Genzyme. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Mr. Preziosa has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Merck. Monica Margoni has received research support from MAGNIMS. Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bayer, Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, Takeda, and Teva Pharmaceutical Industries. Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Bayer, Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, Takeda, and Teva Pharmaceutical Industries. Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, Teva Pharmaceutical Industries, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA). Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Bristol Myers Squibb, Celgene, Genzyme, Merck Serono, Novartis, Roche, and Teva. The institution of Maria Assunta Rocca has received research support from Italian Ministry of Health, MS Society of Canada and Fondazione Italiana Sclerosi Multipla.

Brain atrophy and lesion burden are associated with disability progression in a multiple sclerosis real-world dataset using only T2-FLAIR: The NeuroSTREAM MSBase study

BackgroundMethodological challenges limit the use of brain atrophy and lesion burden measures in the follow-up of multiple sclerosis (MS) patients on clinical routine datasets. ObjectiveTo determine the feasibility of T2-FLAIR-only measures of lateral ventricular volume (LVV) and salient central lesion volume (SCLV), as markers of disability progression (DP) in MS. MethodsA total of 3,228 MS patients from 9 MSBase centers in 5 countries were enrolled. Of those, 2,875 (218 with clinically isolated syndrome, 2,231 with relapsing-remitting and 426 with progressive disease subtype) fulfilled inclusion and exclusion criteria. Patients were scanned on either 1.5 T or 3 T MRI scanners, and 5,750 brain scans were collected at index and on average after 42.3 months at post-index. Demographic and clinical data were collected from the MSBase registry. LVV and SCLV were measured on clinical routine T2-FLAIR images. ResultsLongitudinal LVV and SCLV analyses were successful in 96% of the scans. 57% of patients had scanner-related changes over the follow-up. After correcting for age, sex, disease duration, disability, disease-modifying therapy and LVV at index, and follow-up time, MS patients with DP (n = 671) had significantly greater absolute LVV change compared to stable (n = 1,501) or disability improved (DI, n = 248) MS patients (2.0 mL vs. 1.4 mL vs. 1.1 mL, respectively, ANCOVA p < 0.001, post-hoc pair-wise DP vs. Stable p = 0.003; and DP vs. DI, p = 0.002). Similar ANCOVA model was also significant for SCLV (p = 0.03). ConclusionsLVV-based atrophy and SCLV-based lesion outcomes are feasible on clinically acquired T2-FLAIR scans in a multicenter fashion and are associated with DP over mid-term.

Differentiation of relapsing-remitting and secondary progressive multiple sclerosis: a magnetic resonance spectroscopy study based on machine learning.

Magnetic resonance imaging (MRI) is the most important tool for diagnosis and follow-up in multiple sclerosis (MS). The discrimination of relapsing-remitting MS (RRMS) from secondary progressive MS (SPMS) is clinically difficult, and developing the proposal presented in this study would contribute to the process. This study aimed to ensure the automatic classification of healthy controls, RRMS, and SPMS by using MR spectroscopy and machine learning methods. MR spectroscopy (MRS) was performed on a total of 91 participants, distributed into healthy controls (n=30), RRMS (n=36), and SPMS (n=25). Firstly, MRS metabolites were identified using signal processing techniques. Secondly, feature extraction was performed based on MRS Spectra. N-acetylaspartate (NAA) was the most significant metabolite in differentiating MS types. Lastly, binary classifications (healthy controls-RRMS and RRMS-SPMS) were carried out according to features obtained by the Support Vector Machine algorithm. RRMS cases were differentiated from healthy controls with 85% accuracy, 90.91% sensitivity, and 77.78% specificity. RRMS and SPMS were classified with 83.33% accuracy, 81.81% sensitivity, and 85.71% specificity. A combined analysis of MRS and computer-aided diagnosis may be useful as a complementary imaging technique to determine MS types.

New concepts about the role of magnetic resonance imaging in the diagnosis and follow-up of multiple sclerosis

Magnetic resonance imaging (MRI) is widely considered to be the most important paraclinical technique for establishing an accurate early diagnosis of multiple sclerosis as well as for predicting its prognosis and monitoring and predicting the efficacy of different treatments for this disease. In recent years, new imaging findings for multiple sclerosis have been described, and new evidence about the role of MRI in the follow-up of this disease has accumulated. Moreover, the European Commission's regulations of the use of gadolinium-based contrast agents have required that the indications for their use in clinical practice be revised and restricted. Radiologists need to be familiar with these developments and recommendations to use MRI appropriately in the diagnosis and follow-up of multiple sclerosis.

Nuevos conceptos sobre el papel de la resonancia magnética en el diagnóstico y seguimiento de la esclerosis múltiple

Magnetic resonance imaging (MRI) is widely considered to be the most important paraclinical technique for establishing an accurate early diagnosis of multiple sclerosis as well as for predicting its prognosis and monitoring and predicting the efficacy of different treatments for this disease. In recent years, new imaging findings for multiple sclerosis have been described, and new evidence about the role of MRI in the follow-up of this disease has accumulated. Moreover, the European Commission's regulations of the use of gadolinium-based contrast agents have required that the indications for their use in clinical practice be revised and restricted. Radiologists need to be familiar with these developments and recommendations to use MRI appropriately in the diagnosis and follow-up of multiple sclerosis.

The role of contrast-enhanced and non-contrast-enhanced MRI in the follow-up of multiple sclerosis.

Magnetic resonance imaging (MRI) is widely used in patients with multiple sclerosis (MS) for different indications. However, frequent administration of gadolinium in these patients can have some potential complications. So, a more limited approach reducing the use of gadolinium should be considered. To evaluate the additional benefits of contrast-enhanced MRI over non-contrast-enhanced MRI in routine follow-up of patients with MS. This is a retrospective cohort study including patients with MS who underwent both contrast-enhanced and non-contrast-enhanced MRI for two time-points with an interval of at least six months. Non-contrast-enhanced images were compared for each patient and interpreted as non-progressive or progressive disease. Then, rate and type of enhancing lesions were analyzed and compared between the groups. All images were reviewed and compared visually by two radiologists. A total of 462 patients (392 women; mean age = 36 years) were included. Of these patients, 352 were in the non-progressive group and 112 were in progressive group. Comparison of baseline and follow-up contrast-enhanced MRIs revealed that 13 (3.7%) patients in the non-progressive group and 58 (51.8%) patients in progressive group developed enhancing lesions (P < 0.001). All 58 patients in the progressive group developed new enhancing lesions, whereas all those in the non-progressive group revealed persistent or reactivated enhancing lesions without evidence of new lesions. According to the very low incidence rate of new enhancing lesions in patients with non-progressive disease on follow-up non-contrast-enhanced MRI, routine administration of contrast in follow-up studies is not suggested.

Should spinal cord MRI be systematically performed for diagnosis and follow-up of multiple sclerosis? Synthesis

Should spinal cord MRI be systematically performed for diagnosis and follow-up of multiple sclerosis? Synthesis

Should spinal cord MRI be systematically performed for diagnosis and follow-up of multiple sclerosis? No

Should spinal cord MRI be systematically performed for diagnosis and follow-up of multiple sclerosis? No

Serum neurofilament light chain reflects inflammation-driven neurodegeneration and predicts delayed brain volume loss in early stage of multiple sclerosis

Background: Serum neurofilament light chain (sNfL) is a marker of neuroaxonal injury. There is a lack of studies investigating the dynamics of relationships between sNfL levels and radiological disease activity over long-term follow-up in multiple sclerosis (MS). Objectives: To investigate the relationship among repeated measures of sNfL, lesion burden accumulation, brain volume loss and clinical measures. Methods: We investigated 172 patients in the early stages of MS (McDonald 2017 criteria). Clinical exams were performed every 3 months and brain magnetic resonance imaging (MRI) scans were collected annually over 48 months. sNfL levels were measured in serum by Simoa assay at the time of treatment initiation and then annually over 36 months. Results: In repeated-measures analysis, considering all time points, we found a strong relationship between percentage changes of sNfL and lesion burden accumulation assessed by T1 lesion volume (p < 0.001) and T2 lesion number (p < 0.001). There was no relationship between percentage changes of sNfL and brain volume loss over 36 months (p > 0.1). Early sNfL levels were associated with delayed brain volume loss after 48 months (p < 0.001). Patients with No Evidence of Disease Activity (NEDA-3) status showed lower sNfL levels compared with active MS patients. Conclusions: sNfL is associated with ongoing neuroinflammation and predictive of future neurodegeneration in early MS.

A fully automated pipeline for brain structure segmentation in multiple sclerosis

Accurate volume measurements of the brain structures are important for treatment evaluation and disease follow-up in multiple sclerosis (MS) patients. With the aim of obtaining reproducible measurements and avoiding the intra-/inter-rater variability that manual delineations introduce, several automated brain structure segmentation strategies have been proposed in recent years. However, most of these strategies tend to be affected by the abnormal MS lesion intensities, which corrupt the structure segmentation result. To address this problem, we recently reformulated two label fusion strategies of the state of the art, improving their segmentation performance on the lesion areas. Here, we integrate these reformulated strategies in a completely automated pipeline that includes pre-processing (inhomogeneity correction and intensity normalization), atlas selection, masked registration and label fusion, and combine them with an automated lesion segmentation method of the state of the art. We study the effect of automating the lesion mask acquisition on the structure segmentation result, analyzing the output of the proposed pipeline when used in combination with manually and automatically segmented lesion masks. We further analyze the effect of those masks on the segmentation result of the original label fusion strategies when combined with the well-established pre-processing step of lesion filling. The experiments performed show that, when the original methods are used to segment the lesion-filled images, significant structure volume differences are observed in a comparison between manually and automatically segmented lesion masks. The results indicate a mean volume decrease of 1.13%±1.93 in the cerebrospinal fluid, and a mean volume increase of 0.13%±0.14 and 0.05%±0.08 in the cerebral white matter and cerebellar gray matter, respectively. On the other hand, no significant volume differences were found when the proposed automated pipeline was used for segmentation, which demonstrates its robustness against variations in the lesion mask used.

Neurofilaments and 10-year follow-up in multiple sclerosis

Background: The role of biomarkers to predict clinical outcome in multiple sclerosis (MS) is still debated. Objective: To test whether cerebrospinal fluid (CSF) light-chain neurofilament (NfL) levels in newly diagnosed patients with MS could predict clinical outcome over a 10-year period. Methods: Patients with newly diagnosed MS underwent standardized clinical assessments at baseline and 5 and 10 years of follow-up. Expanded Disability Status Scale (EDSS) progression between assessments was defined as an increase in one point or more if <6 and 0.5 or more if ≥6. CSF obtained at baseline was analyzed for levels of NfL using enzyme-linked immunosorbent assay technology. Results: A total of 44 patients were included. In all, 35 patients (80%) had relapsing–remitting multiple sclerosis (RRMS). Patients who progressed in EDSS showed a trend for higher median baseline CSF-NfL levels than patients who did not progress after 5 years (947 ng/L vs 246 ng/L, p = 0.05), and although not statistically significant, after 10 years (708 ng/L vs 265 ng/L, p = 0.28). Patients who converted from RRMS to secondary-progressive multiple sclerosis (SPMS) at 5 years had a statistical significant higher median CSF level of NfL (2122 ng/L vs 246 ng/L, p = 0.01). Conclusion: CSF levels of NfL at the time of diagnosis seems to be an early predictive biomarker of long-term clinical outcome and conversion from RRMS to SPMS.

Neurofilament levels, disease activity and brain volume during follow-up in multiple sclerosis

BackgroundThere is a need for clinically useful biomarkers of disease activity in clinically isolated syndrome (CIS) and relapsing remitting MS (RRMS). The aim of this study was to assess the correlation between neurofilament light chain (NFL) in cerebrospinal fluid (CSF) and serum and the relationship between NFL and other biomarkers, subsequent disease activity, and brain volume loss in CIS and RRMS.MethodsA panel of neurodegenerative and neuroinflammatory markers were analyzed in repeated CSF samples from 41 patients with CIS or RRMS in a prospective longitudinal cohort study and from 22 healthy controls. NFL in serum was analyzed using a single-molecule array (Simoa) method. “No evidence of disease activity-3” (NEDA-3) status and brain volume (brain parenchymal fraction calculated using SyMRI®) were recorded during 4 years of follow-up.ResultsNFL levels in CSF and serum correlated significantly (all samples, n = 63, r 0.74, p < 0.001), but CSF-NFL showed an overall stronger association profile with NEDA-3 status, new T2 lesions, and brain volume loss. CSF-NFL was associated with both new T2 lesions and brain volume loss during follow-up, whereas CSF-CHI3L1 was associated mainly with brain volume loss and CXCL1, CXCL10, CXCL13, CCL22, and MMP-9 were associated mainly with new T2 lesions.ConclusionsSerum and CSF levels of NFL correlate, but CSF-NFL predicts and reflects disease activity better than S-NFL. CSF-NFL levels are associated with both new T2 lesions and brain volume loss. Our findings further add to the accumulating evidence that CSF-NFL is a clinically useful biomarker in CIS and RRMS and should be considered in the expanding NEDA concept. CSF-CXCL10 and CSF-CSF-CHI3L1 are potential markers of disease activity and brain volume loss, respectively.

Revised Recommendations of the Consortium of MS Centers Task Force for a Standardized MRI Protocol and Clinical Guidelines for the Diagnosis and Follow-Up of Multiple Sclerosis.

An international group of neurologists and radiologists developed revised guidelines for standardized brain and spinal cord MR imaging for the diagnosis and follow-up of MS. A brain MR imaging with gadolinium is recommended for the diagnosis of MS. A spinal cord MR imaging is recommended if the brain MR imaging is nondiagnostic or if the presenting symptoms are at the level of the spinal cord. A follow-up brain MR imaging with gadolinium is recommended to demonstrate dissemination in time and ongoing clinically silent disease activity while on treatment, to evaluate unexpected clinical worsening, to re-assess the original diagnosis, and as a new baseline before starting or modifying therapy. A routine brain MR imaging should be considered every 6 months to 2 years for all patients with relapsing MS. The brain MR imaging protocol includes 3D T1-weighted, 3D T2-FLAIR, 3D T2-weighted, post-single-dose gadolinium-enhanced T1-weighted sequences, and a DWI sequence. The progressive multifocal leukoencephalopathy surveillance protocol includes FLAIR and DWI sequences only. The spinal cord MR imaging protocol includes sagittal T1-weighted and proton attenuation, STIR or phase-sensitive inversion recovery, axial T2- or T2*-weighted imaging through suspicious lesions, and, in some cases, postcontrast gadolinium-enhanced T1-weighted imaging. The clinical question being addressed should be provided in the requisition for the MR imaging. The radiology report should be descriptive, with results referenced to previous studies. MR imaging studies should be permanently retained and available. The current revision incorporates new clinical information and imaging techniques that have become more available.

A toolbox for multiple sclerosis lesion segmentation.

Lesion segmentation plays an important role in the diagnosis and follow-up of multiple sclerosis (MS). This task is very time-consuming and subject to intra- and inter-rater variability. In this paper, we present a new tool for automated MS lesion segmentation using T1w and fluid-attenuated inversion recovery (FLAIR) images. Our approach is based on two main steps, initial brain tissue segmentation according to the gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) performed in T1w images, followed by a second step where the lesions are segmented as outliers to the normal apparent GM brain tissue on the FLAIR image. The tool has been validated using data from more than 100 MS patients acquired with different scanners and at different magnetic field strengths. Quantitative evaluation provided a better performance in terms of precision while maintaining similar results on sensitivity and Dice similarity measures compared with those of other approaches. Our tool is implemented as a publicly available SPM8/12 extension that can be used by both the medical and research communities.

There is still a role for the blink reflex in the diagnosis and follow-up of multiple sclerosis

ObjectiveThe evolution of the diagnostic criteria for multiple sclerosis (MS) has essentially evolved to clinical manifestations and magnetic resonance imaging. Inexpensive, quick to apply, non-invasive, quantitative and reliable neurophysiological tests are rare in daily practice and absent in clinical trials. MethodThe blink reflex was assessed in 50 patients with remitting-relapsing MS (RRMS) and 100 matched controls. ResultsPatients with RRMS had abnormalities in the blink reflex waves in relation to controls. If only RRMS patients were considered, these abnormalities were more pronounced in patients with longer disease duration, higher disability and for those with clinical or image lesions in the brainstem. ConclusionNeurophysiological tests, such as the blink reflex, can be used for helping the diagnosis and follow-up of patients with RRMS, since the reflex can identify dissemination in time and in space in a clear and quantitative manner. SignificancePotential good methods for diagnosis and follow-up of MS should be considered for clinical trials and daily practice.

FP14-TU-01 Consortium of multiple sclerosis centers (CMSC) guidelines for a standardized MRI protocol for the diagnosis and follow-up of multiple sclerosis: 2009 revision

FP14-TU-01 Consortium of multiple sclerosis centers (CMSC) guidelines for a standardized MRI protocol for the diagnosis and follow-up of multiple sclerosis: 2009 revision

Corpus Callosum Index: A practical method for long-term follow-up in multiple sclerosis

Rather than acute inflammation, long-standing multiple sclerosis (MS) course is hallmarked by relentless axonal loss and brain atrophy, both with subtle clinical expression and scarcely visible on conventional MRI studies. Brain atrophy imaging has sophisticated methodological requirements, not always practical and accessible to most centers. Corpus callosum (CC) is a major inter-hemispheric white matter bundle, grossly affected by long term MS and easily assessed by MRI. To determine whether a practical imaging method can reliably follow presumed axonal loss in patients with progressive MS, we designed a 5-year prospective open label study, enrolling 128 consecutive patients (75 relapsing-remitting (RR) and 53 secondary-progressive (SP)), on regular immunomodulatory therapy compared to control group, formed by 23 patients with MRI considered normal. On a conventional best mid-sagittal T1W, CC index (CCI) was obtained by measuring anterior, medium and posterior segments of CC, normalized to its greatest anteroposterior diameter using an orthogonal semi-automated linear system. CCI was measured at baseline and at least once yearly. Results were plotted intra-individually; baseline values were used as reference. At baseline, CCI was able to distinguish SP patients from RR and controls, and on follow-up, despite some overlap, demonstrated a progressive reduction from baseline on both RR and SP groups compared to controls. From the third year on, difference between SP and RR patients reached statistical significance, which did not correlated with disability measured by EDSS. So, a corpus callosum index proved practical and feasible to longitudinally demonstrate morphometric callosal changes with potential to be used as a tool for long-term follow-up, mostly in SP patients.

Sequential magnetic resonance imaging follow-up of multiple sclerosis before the clinical phase

There is much evidence of the importance of the preclinical phase of multiple sclerosis (MS). However, apart from a recent report of the incidental discovery of a case of primary progressive MS, there are no data on the sequential magnetic resonance imaging (MRI) follow-up of patients before the clinical phase. We report the incidental discovery of white matter changes on MRI and their follow-up in a patient three years before the first neurological event (optic neuritis). A 34-year-old woman presented with headaches and depression after her young daughter had been involved in a car accident and spent two weeks in intensive care. The woman's general practitioner performed a brain MRI, which revealed multiple T2-weighted hypersignals suggesting MS. During the next three years, clinical examination remained normal but we observed new T2 lesions and/or new enhanced T1 lesions after gadolinium infusion on the four successive MRIs. Thirty-seven months after the first MRI, the patient developed a right optic neuritis. The diagnosis of MS was made according to space and time dissemination on MRI criteria. We proposed a treatment with Interferon Beta 1a (Avonex).