Even patients presenting with their first attack of multiple sclerosis have iron deposits in their brains.

In a recent study, led by Ravi Menon of the Robarts Research Institute in Canada, researchers used magnetic resonance imaging (MRI) to examine iron deposits in the brains of multiple sclerosis (MS) patients. What Menon’s team found was a connection between the amount of iron present in the brain and the patient’s level of disability.

“We’ve known for about 150 years about the importance of iron to the pathology of MS,” Menon explained in a video. “So, we started to look at this using MRI, which can detect such iron [in a living person]…to see if this starts very early in the disease process or whether it’s something that accumulates with time.”

To do this, they scanned 22 patients who had not yet been diagnosed with MS but who had clinically isolated syndrome (CIS) characteristic of an initial MS attack. To be diagnosed with MS, according to the McDonald Criteria, you must have at least two episodes of CIS with two different brain lesions.

Half of all patients who have CIS are eventually diagnosed with MS, while the other half are diagnosed with other diseases.

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According to Menon, what they found was a “much higher level of iron—well above what you would expect in age-matched controls—in the MS patients’ brains.”

Researchers also looked at the diameter of the patients’ neck veins during the MRI scans. Insufficient drainage of the jugular veins is part of Dr. Paolo Zamboni’s theory of a phenomenon called chronic cerebrospinal venous insufficiency (CCSVI), which may contribute to nervous system damage in MS.

This study, along with other resent research, revealed no connection between vein drainage and MS.

“While iron in the brain correlates with the disability in the subjects, the iron in the brain does not correlate in any way with the actual diameter of the jugular veins in these patients,” explained Menon. “So the Zamboni hypothesis is incorrect insofar as iron is related to some kind of obstruction in their veins, but the fact is, there is iron at very early stages of MS.”

Menon’s group identified subtle changes in the brain’s white matter in those with CIS, indicating that damage occurs even in the very early stages of MS. The white matter damage also correlated with the amount of iron in the brain, suggesting that iron plays a significant role in the MS disease process and resulting disability.

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The researchers will continue to follow these 22 patients with CIS, scanning them every four months over the next two years. They hope to find out what characterizes the difference between those who are eventually diagnosed with MS and those who are not.

Because iron deposits are present even in those with CIS, at the earliest stages of MS, scanning to measure the level of iron in someone’s brain may become a new tool for early detection. This could allow neurologists to start their patients on drug therapy sooner, getting a jump on disease progression.

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