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Neurology

Multiple sclerosis: Improve monitoring, inform treatment decisions

When it comes to clinical research, the whole is more than the sum of its parts.
3min
Doris Pischitz
Published on April 21, 2022

Research into multiple sclerosis (MS) is no exception. Ten leading clinical centers, the biotechnology company Biogen, and Siemens Healthineers have joined forces to help combat this disease of the central nervous system.

Multiple sclerosis (MS) is an autoimmune disease that causes the body's immune system to destroy myelin, the fatty substance that coats and protects axons in the brain and spinal cord. This damage prevents the transmission of nerve signals between different parts of the brain, spinal cord, and other parts of the body. It also leads to the death of the affected nerve cells. 

What is an axon?

An axon is a nerve fiber.
A neurologist’s diagnosis of MS is usually based on medical history, a neurological exam, magnetic resonance imaging (MRI), and sometimes cerebrospinal fluid (CSF) analysis and blood tests to rule out other conditions. Although there is currently no cure for MS, it is possible to reduce disease flare-ups and slow the progression of disability with disease-modifying drugs. Biogen and other companies have made significant advances in these drugs, which help to control MS increasingly well. There are now over 16 treatments approved for MS.[1] However, the disease can vary significantly – both from person to person and over time in a single person – which complicates treatment decisions. Regular MRI monitoring is necessary to assess how a person with MS is doing on their specific treatment. It helps doctors see whether the treatment is adequately controlling the disease or if a higher efficacy or alternate treatment is needed. The monitoring can also detect potentially dangerous side effects as early as possible.

What is cerebrospinal fluid?

Cerebrospinal fluid (CSF) is a clear liquid that surrounds the brain and spinal cord.
Multiple sclerosis: Doctor talking to a patient

Digging into real-world data

The complexity of MS and the subjective nature of routine clinical assessments mean that treating MS is more of an art than a science. In an ambitious collaboration project, the biotechnology company Biogen, a major player in MS drug development, is working to change this by introducing digital technology into routine care to enable more quantitative and reliable measurements for monitoring patients with MS. Ten leading clinical centers in the U.S., Germany, and Spain partnered with Biogen in 2016 to use real-world data from sources such as digital neuro-performance tests, imaging studies, and optional blood testing to gain a better understanding of MS and potentially transform patient care. By fall 2021, the MS PATHS program (Multiple Sclerosis Partners Advancing Technology and Health Solutions) had collected more than 30,000 imaging datasets from more than 18,000 unique patients.
Multiple sclerosis: Patient undergoing a head MRI exam

The role of imaging

Through a collaboration with Siemens Healthineers, the program also includes the MS PATHS Image Evaluation (MSPie) prototype1, which aims to provide MRI-based metrics at the point of care and integrated into the radiologist’s workflow. MRI scans provide physicians with a significant amount of information that they use to monitor MS disease activity and progression. The aim of MSPie is to provide quantifiable information on the most important imaging biomarkers in MS: the number and volume of new lesions, and measures of brain atrophy. MSPie also requires a harmonized MRI protocol at the participating sites so that examinations from different sites can be compared and the highest possible imaging quality achieved.

MS on MRI images

Multiple sclerosis on MRI images - T2 FLAIR imaging
T2 FLAIR imaging
Lesions that are hyperintense on T2-weighted MR images can indicate areas of MS demyelination and damage to the CNS. In the images, MS lesions appear bright. On a single scan, the total volume of lesions can be used to quantify the disease burden that a patient has accumulated over time. New lesions that have appeared since the previous MRI are a marker of MS disease activity and are commonly used in routine check-ups to monitor a person’s response to therapy. All currently available MS treatments work by reducing MS inflammatory activity. The new or enlarging T2 lesion count helps neurologists decide whether it is necessary to switch to a different treatment.
MSPie1 uses artificial intelligence (AI) to aid radiologists in MRI-based assessments of MS. Immediately after image acquisition, MSPie automatically identifies and counts lesions that have developed since the patient’s last MRI, while also quantifying the overall lesion burden. MSPie also provides a robust and precise evaluation of brain volume to quantify atrophy. Radiologists can review and verify the results before they are stored in the picture archiving and communication system (PACS) for access by the treating physician. The data generated by AI-based brain and lesion segmentation and volumetric measurements may help radiologists and neurologists to objectively evaluate MS disease activity, progression, and therapy response. In turn, this can support them in making reliable data-driven treatment decisions for individual patients.

Irregular breathing

Irregular breathing means that the patient has an erratic respiration rate or amplitude – simply put – inhales irregularly and/or at different depths.

Precision diagnostics, precision treatment

A more precise classification of MS patients that is based on the underlying biological differences and changes over time as studied in the MS PATHS program may enable new treatments that are more targeted to the individual’s disease status, prognosis, and treatment response. Making such advances a reality will require close cooperation between pharmaceutical companies, academic institutes, patient societies, medical technology firms, and bioinformatics companies – in other words, exactly the type of collaboration described in this article.
By Doris Pischitz
Doris Pischitz is an editor in corporate communications at Siemens Healthineers. The team specializes in topics related to healthcare, medical technology, disease areas, and digitalization.

Read more

Neurology

Zooming in on the brain’s microarchitecture
  1. [1] Ø Torkildsen, K-M Myhr, and L Bø: Disease-modifying treatments for multiple sclerosis – a review of approved medications. Eur J Neurol. 2016 Jan; 23(Suppl 1): 18–27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670697/

  2. 1 The product/feature is still under development and not commercially available yet. Its future availability cannot be ensured.

  3. The concepts and information presented in this paper are based on research and are not commercially available. The statements by Siemens Healthineers customers described herein are based on results that were achieved in the customer’s unique setting. Since there is no “typical” hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.