To the Editor The recent publication by Zurawski et al1 concerning the possibility of leptomeningeal enhancement as a potential radiological marker for progressive multiple sclerosis (MS) is timely and interesting. Given the startling findings by Cree et al2 that questioned no evidence of disease activity theories that MS researchers and physicians have embraced, including using frequent magnetic resonance imaging to “track disease progression,” MS research needs to pivot its course and track the disease differently. Cortical pathology and lesions in the deep gray matter take center stage as we try to understand why MS therapies are so limited in their effectiveness in controlling disability. From a therapeutic perspective, we need models that combine using small molecules that penetrate an intact blood-brain barrier with monoclonal antibodies (that address disease peripherally) from the earliest sign of the disease or we will continue to chase an elusive target.
Avasarala J. Leptomeningeal Enhancement for Multiple Sclerosis: Another Radiological Biomarker for a Relapse? JAMA Neurol. 2017;74(6):745–746. doi:10.1001/jamaneurol.2017.0123
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