Neurologists are looking for “NED,” or no evidence of disease.
The primary goal of medications for multiple sclerosis is to delay or prevent attacks on the central nervous system. No attacks means no new lesions, which means no new or worsened MS symptoms. It can be tough to tell if your new treatment is doing its job and warding off relapses—or simply doing nothing.
“That’s one of the most common questions people ask us: ‘How do I know this is working in my body?’” says Michelle Fabian, MD, a neurologist at The Mount Sinai Hospital. “We have these measures that we use. It’s called NEDA: No Evidence of Disease Activity.”
Doctors check a few criteria to assess how well a medication is working to treat multiple sclerosis.
Signs of MS relapse. If your MS treatment is working well, you should be experiencing no new symptoms from a relapse, a flare-up that causes an attack on the central nervous system. Learn more about MS relapses here.
MRI results. Your scan should not show any new MS lesions on the body if the treatment is working.
Physical exams. Doctors will check your coordination, eye movement, arm and leg strength, and reflexes. “We look at their examinations and make sure that it looks stable,” says Dr. Fabian, “[and] there are no changes from the last one.”
If those markers check out, you’ve achieved NEDA, and your MS medication is considered to be working successfully.
“Some patients will say, ‘How do we know it’s not just me? How do we know it’s the drug?’” says Dr. Fabian. The truth is, there’s no sure way to tell. “If you’re on the drug, and you’re stable, we say that’s great.”
In addition to checking the drug’s effectiveness, your doc will also make sure you’re not experiencing any unwanted side effects about a month after starting a new MS treatment. At the six-month mark, your doctor may do an MRI to check for visual evidence of any possible lesions.
“We wait six months because most of our treatments take time to work,” says Dr. Fabian. “If that looks good, then we usually check MRIs every year.” Besides annual MRI scans, MS patients typically see their doctor every three to six months for physical exams.
Thanks to newer MS treatment options, relapses are surprisingly infrequent—about every one in eight years or less. That’s good news: Preventing a relapse is the best way to keep MS symptoms from progressing. Here’s what doctors recommend to prevent and treat MS relapses.
Dr. Fabian is the assistant professor of neurology at The Mount Sinai Hospital in New York City.
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It is really confusing, I think,
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for a patient at first to know if their
drug is working, and so that's one of
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the most common questions people ask us,
how do I know this is working in my body?
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And so we have these measures that we use,
it's called NEDA,
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no evidence of disease activity.
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So we want a patient who goes on to a drug
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to have no evidence of
the activity in their body.
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And how do we do that?
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We ask them if they've had any relapses,
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we don't want them to
have any new MS relapses.
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We check the MRI and
make sure they have no new lesions.
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And we look at their examination and
we make sure that it looks stable.
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That there's no changes from the last one.
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If they've met all those markers,
they've achieved NEDA,
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No Evidence of Disease Activity.
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And some patients will say how
do we know that's not just me,
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how do we know it's the drug.
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We don't, but if you're on the drug and
you're stable, we say that's great.
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When a person starts a new medication
they come in to see us usually
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about a month later.
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Because we wanna make sure that
they don't have any side effects,
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that they're remembering to take it,
that everything's going okay with it.
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And then usually what we'll do is check
a new MRI about 6 month after they start
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the medication to make
sure it looks steady.
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That there's not new active lesions
forming while they're on the treatment.
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But we wait six months because most
of our treatments take time to work.
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So they don't work right away.
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And so because of that we give
it a six month period of time.
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If that looks good then we
usually check MRIs every year.
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If a patient's doing well on their
treatment they usually can space out
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the appointments to every
three to six months.
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Relapses are actually very infrequent, now
that we have very good treatments for MS.
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In our trials patients have relapses
every one in eight years or less and so
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a relapse should be
a signal to a patient and
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doctor that they need to think
about the treatment they're on.
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Loma I, Heyman R. Multiple sclerosis: pathogenesis and treatment. Curr Neuropharmacol. 2011 Sep;9(3):409-416.Medications. New York, NY: National Multiple Sclerosis. (Accessed on April 12, 2021 at https://www.nationalmssociety.org/Treating-MS/Medications.) What is relapsing-remitting multiple sclerosis? Baltimore, MD: Johns Hopkins Medicine. (Accessed on April 12, 2021 at https://www.hopkinsmedicine.org/healthlibrary/conditions/nervous_system_disorders/relapsing-remitting_multiple_sclerosis_134,54.)