Streamlining MS Diagnosis and Treatment Through Effective Localization: Aliza Ben-Zacharia, PhD, DNP, ANP-BC, FAAN

WATCH TIME: 7 minutes

“As an MS expert, everyone has their own system of how they do things and their own patterns and methods, but it is very important to localize. It’s helpful for you, as a clinician, to create the plan and think where you’re going from there.”

Multiple sclerosis (MS), an inflammatory demyelinating disease, often leads to the formation of brain lesions that can cause various debilitating effects among patients. Previous research utilizing MRI has enabled investigators to study the occurrence patterns of these lesions. These such studies have shown that the nature of the resulting disabilities heavily depends on the location of the lesions in the brain; however, this issue is complex, as increased disability may not always correspond to noticeable changes on MRI scans or a significant increase in lesion burden^.1 Thus, there is a need for more research on the association between brain lesion location and MS disease severity.

In previous research, the study of lesion localization has yielded significant quantitative results. One notable study reported an association between lesion load and disability score using standard linear regression at every voxel, with areas of significant association estimated through t-statistic map thresholds.² Subsequent research explored the relationship between average cortical thickness, lesion load, and disability score, revealing that cortical atrophy can occur even in patients with MS who had low disability scores.³ Additionally, 2 other related studies examined the association of gray matter volume reduction with the localization of white matter lesions.^4,5 Therefore, the continued efforts of studying localization can help with informing clinicians on how to appropriately diagnosis MS among their patients.

At the 2024 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 29 to June 1, in Nashville, Tennessee, Aliza Ben-Zacharia, PhD, DNP, ANP-BC, FAAN, assistant professor at Hunter College Bellevue School of Nursing, presented a talk on clinical pearls and the spinal cord in MS. Ben-Zacharia, a nurse practitioner in New York City, sat down with NeurologyLive^® during the meeting to discuss why localization is critical in diagnosing the disease. In addition, Ben-Zacharia, who also serves as an assistant professor at Icahn School of Medicine at Mount Sinai, spoke about how clinicians can ensure they make the right diagnosis and avoid misdiagnosis in MS. Moreover, she spoke about the role of listening to patients’ history plays in diagnosing and treating MS.

Click here for more coverage of CMSC 2024.

REFERENCES
1. Eloyan A, Shou H, Shinohara RT, et al. Health effects of lesion localization in multiple sclerosis: spatial registration and confounding adjustment. PLoS One. 2014;9(9):e107263. Published 2014 Sep 18. doi:10.1371/journal.pone.0107263
2. Charil A, Zijdenbos AP, Taylor J, et al. Statistical mapping analysis of lesion location and neurological disability in multiple sclerosis: application to 452 patient data sets. Neuroimage. 2003;19(3):532-544. doi:10.1016/s1053-8119(03)00117-4
3. Charil A, Dagher A, Lerch JP, Zijdenbos AP, Worsley KJ, Evans AC. Focal cortical atrophy in multiple sclerosis: relation to lesion load and disability. Neuroimage. 2007;34(2):509-517. doi:10.1016/j.neuroimage.2006.10.006
4. Sepulcre J, Goñi J, Masdeu JC, et al. Contribution of white matter lesions to gray matter atrophy in multiple sclerosis: evidence from voxel-based analysis of T1 lesions in the visual pathway. Arch Neurol. 2009;66(2):173-179. doi:10.1001/archneurol.2008.562
5. Bendfeldt K, Blumhagen JO, Egger H, et al. Spatiotemporal distribution pattern of white matter lesion volumes and their association with regional grey matter volume reductions in relapsing-remitting multiple sclerosis. Hum Brain Mapp. 2010;31(10):1542-1555. doi:10.1002/hbm.20951