Lesions active for a year?

[amyrising]

I had so many questions yesterday that I forgot to ask...imagine that When I got home I was thinking about the MRI comparison we did. One MRI was from last year and the other from last week. Several (2) of my lesions from last year were still active. Is that normal? The only time I felt my symtoms lessen was when by trial and error my MD put me on Gabapentin. I had some relief of pain and some clearing of my mind. The issues never went completely away and I developed anxiety/panic attacks. The pain returned with a vengence and the doctor took me off the Gabapentin (instead of increasing it). Is it possible to be in relapse this long?

[JerryD]

Wow, this is a new one on me. And I've been reading this board for about 4 years. I have read that neuro's prescribe steroids for inflammation. I think your question is best answered by your neurologist. Good luck

[MSer102]

Is it possible to be in relapse this long?

Well I suppose that all kinds of things are possible but from everything I've read the answer is no. I think the answer can vary a bit depending on if your basing the definition of relapse on inflamed lesions found on an MRI or symptoms that came with the relapse. But in the end the answer is still probably no.

You brought up your MRI's. The characteristic of relapsing-remitting MS is that inflammation and relapses come and go in definite attacks. That's what makes it relapsing and remitting. I have read in several places that lesions are "active" for only a few weeks. They take up gadolinium dye and "enhance" on MRI for only about 4 to 6 weeks.

However that doesn't mean that the same areas are only active once at the time they form and that they can never become inflamed again at another time. Lesions can come and go and change regularly. So sometimes it's hard to define a relapse by what an MRI shows because lesions can change over time without causing any definite change in symptoms.

So based on the principle of relapsing remitting I think it's more likely that those spots on your MRI that enhanced became actively inflamed again recently and this MRI just happened to catch them in their inflamed state. If you were to have another MRI in a couple of months those areas might not be active but other ones might be that weren't this time around.

The definition of a relapse right now is based on symptoms and not on an MRI. The onset of new or worsening of existing symptoms is considered to be a relapse under most conditions. But symptoms don't always go away when the inflammatory attack is over. So it makes it harder to know when a relapse is over.

Symptoms that don't clear up after a few weeks or months seem to fall into a different category. They aren't the "relapse" anymore. They're the "new normal". So if you still have the same symptoms or "issues" after a year you are probably not "still" in a relapse. You've most likely had permanent damage that isn't necessarily inflammatory anymore and this is your new normal.

And by the way it was obvious from your first post that you have anxiety issues. Anxiety makes everything worse. The people with MS who have the hardest time dealing with it are the ones who have anxiety. It isn't enough just to acknowledge it. It really has to be worked on so you can "get out of your own way" when it comes to dealing with MS. Often it takes more than just medication to do that. I hope you are able to get your anxiety under control because it will make living with MS a lot easier.

[JBWInColorado]

So let me see if I understand this:
Flare ups/symptoms start when a lesion becomes active?

Can lesions that aren't active/enhanced on MRI become active again at a later time?

[amyrising]

I didn't use to have anxiety, now it is very uncontrollable. A big portion of that is my job. I have so much responsibility and no help and I can't afford to lose it. They are not very forgiving either and I have been "off my game" for far to long (in their opinion). The worse I feel the harder they seem to push. I am the bread winner of the family. My husband also works but I make the majority of our money. Acckkk, I'm a mess!

[MrsBones]

So let me see if I understand this:
Flare ups/symptoms start when a lesion becomes active?

Can lesions that aren't active/enhanced on MRI become active again at a later time?

Yup. Lesions can "reactivate". This is how some become larger, some even joining with nearby lesions.

Relapses do occur when lesions are active, but it is entirely possible for a relapse to not match up with an active lesion. You can have a relapse without a visible active lesion and you can have active lesions without symptoms.