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Interview with Massimo Filippi: Diagnosis of Multiple Sclerosis –The Role of Cortical Lesions


Professor Filippi explained that the diagnosis of multiple sclerosis is mainly based on:

Demonstration of the dissemination of the disease in space (multiple areas of the CNS).
Demonstration of the dissemination of the disease in time. The disease must hit the disease in different phases and under different conditions.
Exclusion of other conditions.

Professor Filippi emphasised that magnetic resonance imaging (MRI) lesions can now be seen at the first onset of the disease, when these lesions are clinically silent. The time dependency of these lesions can be followed with serial MR scans or by injecting the contrast material gadolinium, which is enhanced by active lesions. This has led to worldwide accepted criteria for the diagnosis of MS, based on clinical and MRI findings. The diagnosis is also earlier with MRI, which is essential for early treatment, which is much more effective in modifying the subsequent disease evolution.

According to Professor Filippi, there are also lesions in the cortex, which require special MR sequences. Cortical lesions do not develop immediately at the biological onset of the disease. Cortical lesions may also help to distinguish MS from other conditions, in which these lesions are rarer and have a different appearance.

Professor Massimo Filippi is Professor of Neurology, Università Vita e Salute, OSR, Milan, Italy

This interview has been recorded just before ECTRIMS 2015, 23 September, Milan, Italy.