Cat: I have a question from the Shift MS community that I wanted to ask you. So at my last MS appointment I asked about my MRI and if there was any indication of brain volume loss. My neurologist said they don’t have a good way to measure it routinely, is this correct and do I have any options?
Professor Gavin Giovannoni, Neurologist: Well, you can measure brain volume loss. The problem is, most routine diagnostic departments don’t have the software or the techniques available to measure it routinely. And so it’s not quite correct to say you don’t have it available because some centres are actually now using or measuring brain volume loss. We are in our centre. But we’re not using it yet in the clinic, we’re using it to get a feel for things. You can actually look at the brain scan and see if there’s brain volume loss, but that’s probably too late then in the sense that if you can see it with your, what I call microscopically, just by looking at the screen with your naked eye, it means it’s quite severe. I think what we try to do is pick up brain volume loss when it’s very, very subtle early on, and for that what we need is serial scans. So years apart, and then what we do is we register them on top of each other and we can pick up subtle volume changes. And we’re talking about volume changes like half a per cent, one per cent per year. And what’s more important though is not really the changes over one year, but changes over two, three and four years. And the simple reason is, the method of measuring brain volume is quite variable, and so the error rate is about half a per cent per year, and so to reduce the error rate you really need to look at it over a long period of time.
But I think it’s becoming important now because we know that brain volume loss or accelerated brain volume loss is a very, very important outcome measure for people with the disease. If you do have accelerated brain volume loss you’re going to do badly in the future, so we would like to change medications or get you on more effective therapies, that’s how they’re processed now. So it’s kind of the next frontier in what we’re measuring clinically, is not only looking at the brain scans for new lesions – these are the little scar tissues, the white blobs – but also looking at the effect of the disease on the volume of the brain, because the volume of the brain really correlates with the nerve cells and what we’re trying to do with our treatment is slow down or stop, if possible, the loss of nerve cells. I say slow down, is because it’s also part of normal ageing, after the age of 35 we all find our brain shrinking. So what we’re looking at here is over and above what’s normal for your age, so it’s what we call accelerated ageing, it’s accelerated brain volume loss, that’s what we’re targeting.
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Professor Gavin Giovannoni has an MBBCh, PhD, FCP (Neurol., SA), FRCP, FRCPath amongst his qualifications. He is the Chair of Neurology at Barts and The London School of Medicine. His research interests have focused around multiple sclerosis and inflammatory disorders of the central nervous system. His teaching focuses on clinical neurology and neuroimmunology.