Multiple sclerosis (MS) is an autoimmune disorder of the brain that leads to problems with walking, seeing, sensation, thinking and bladder control. People with MS are able to access many treatments that can reduce the chances of relapses leading to these symptoms but each treatment comes with a range of risks and side effects, so choosing a treatment that is right for each patient can take time. Patients might need to stop or switch treatments due to various reasons including adverse side effects, pregnancy and transition to a more progressive stage of the disease where there are no clinically obvious relapses or inflammation and most currently available treatments have not proven to be effective. Recently, it has been found that patients on certain treatments do not develop a protective immune response following the COVID-19 vaccination, meaning they and their doctors may wish to temporarily stop therapy to be vaccinated. Currently, it is difficult to evaluate the risk to individual patients when stopping or pausing treatment, balancing the potential risks of more relapses or worsening disease without treatment versus side effects of continuing therapy. This research aims to carefully examine how inflammation in the brain is affected by treatment switching or cessation using the latest brain imaging technologies to identifying patients at risk of worsening disease.
Patients will have brain scans using a 7 Tesla (7T) MRI system which is over twice as powerful as the most powerful scanners available in hospitals. The greater the magnetic strength of an MRI system, the better the image resolution achievable. Therefore, using this high-powered scanner, smaller and subtler changes of ongoing disease activity in the brain can be seen, which potentially allows clinicians and patients to have more time to discuss their therapy and act to stop the disease worsening quickly. Also, in patients who are free of relapses with stable symptoms for many years, a powerful scanner can also potentially detect very low levels of inflammation that are not seen on regular MRIs to help distinguish between patients who could safely stop treatment versus those who may still be benefiting from ongoing therapy.