PMC10117757_01
Fluid attenuated inversion recovery axial sequences of MRI scans performed in the patient over time. (A) Baseline MRI on 11/07/2002; (B) MRI on the left (10/01/2003) with a new parietal right lesion (red arrow) (new cortical frontal lesion not shown), MRI on the right (12/09/2003) with a new frontal periventricular right lesion (red arrow) (left periventricular and left temporoparietal junction new lesions not shown); (C) MRI on the left (29/11/2004) showing a new left corona radiata lesion (other three new lesions not shown), MRI on the right (20/05/2005) showing a new supratrigonal right lesion (red arrow); and (D) last MRI on 15/01/2021.
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F1
The MRI showed the altered signal intensity of the semioval center, trunk, and genu of the corpus callosum and retro-trigonal area bilaterally (Figure 1A). In January 2003, the brain MRI showed a new cortical parietal area and a frontal area, without contrast enhancement (Figure 1B). The following MRIs in September 2003, November 2004, and May 2005 (Figures 1B, C) showed new small lesions (one lesion from a 2005 MRI with contrast enhancement), thus, even in the absence of any clinical onset, intramuscular INF-beta1a was prescribed on a compassionate-use basis in May 2005 to avoid further accumulation of MRI lesions. The last brain and spine MRI performed in January 2021 was stable (Figure 1D), and the last neurological exam was normal except for mild hyperreflexia on both legs and impaired tandem walking (EDSS 1.5).
The number of new lesions in MRI follow-up and EDSS change. The number of lesions detected on MRIs performed during the follow-up is shown (blue columns). The x-axis represents time, the yaxis represents the number of new lesions on MRIs and EDSS. At the top of the table, the line stands for the time under treatment with INF beta or peginterferon. The dashed line stands for periods of irregular intake of the medication.
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F2
Because the drug was poorly tolerated and MRIs were stable (Figure 2), the medication was stopped in April 2007. Then, the patient spontaneously interrupted the treatment and new lesions appeared in June 2010 and December 2010 on brain MRIs (Figure 2).