Objective:

This retrospective chart review aims to distinguish whether radiologic changes and disability progression in patients with MS who received brain radiation are attributable to neurotoxicity of treatment or may represent a reactionary flaring of their underlying autoimmune disease.

Background:

Radiation therapy is a cornerstone in the treatment of intracranial neoplasms despite a degree of associated neurotoxicity. Previous work has shown that radiation may exacerbate multiple sclerosis, though data is limited.

Design/Methods:

We identified a cohort of 5 subjects with MS and brain tumors and 5 controls matched for age, tumor type, and tumor location. We reviewed MRI imaging and clinical documentation before and throughout the first year following treatment to understand the progression of disability in each group. We reviewed radiation planning documentation detailing dosages and treatment fields. We calculated EDSS scores for each patient before and after radiation treatment. 

Results:

While 3 patients followed an uncomplicated course on imaging, there were 7 patients (5 MS and 2 control) that demonstrated MRI evidence of post treatment effects including radiation necrosis/gliosis within the follow-up period. One MS patient experienced a significant clinical decline following treatment, which included new onset weakness, numbness, and difficulty walking. Two control patients experienced mild clinical decline, which included new onsets of weakness and balance problems. With appropriate rehabilitation, two control patients experienced a reduction in symptoms and demonstrated clinical improvement.

Conclusions:

This study affirms that patients who receive radiation to the brain often end up experiencing a complicated clinical course, both with and without underlying demyelinating disease. Imaging changes are common, though most patients are clinically stable after treatment. Larger cohorts are needed to investigate possible group differences.