Multiple Sclerosis and Gad Deposition Disease. Catching the Tiger by the Toe

The first descriptions of high T1 signal in the brain, in the Dentate Nucleus and Globus Pallidus, were in Multiple Sclerosis (MS) patients, and the initial literature thought this high signal was actually progressed MS, when in fact it was Gd deposited in this location. My team and I have written atleast 8 or so papers on this observation on MR images. Turns out this is primarily seen in patients who received multiple injections of Omniscan, essentially never seen in macrocyclic agents- even though Gd is still deposited.

I have avoided the subject of GDD in MS, for a number of reasons. But it seems logical that GDD must also occur in MS... just difficult to recognize because of the overlap in symptoms. Perhaps skin burning may be one that separates GDD from MS.

The below is a current communication with an MS individual:

Yes in some individuals the symptoms of GDD can come on some months later. If skin burning and a cutting sensation developed that you did not have before with Multiple Sclerosis (MS), this does sound like GDD, and early acute hypersensitivity reaction (AHR) especially with subcutaneous injection that you had with the last GBCA injection also fits the entire picture. That includes disease progressing from AHR to GDD

Now one critical problem we face with you is that you have had 20 prior GBCA injections, and as you would have read in my blogs, all of them have left some Gd behind. So if we chelate you, with the first chelation we essentially remobilize almost an entire dose equivalent of GBCA, and that translates into re-equilibration movement of Gd will be massive. We would want to recapture the re-equilibrating Gd so you don't get worsening GDD from re-equilibration. That means we would have to commit to atleast 20 chelation sessions, and our standard of 3 weeks apart may be too long for you.

So if symptoms that appear to you not to be MS, but more in line with GDD (skin burning) are now diminishing, we may want to hold off chelation, because once we start remobilizing Gd from 20 prior GBCA injections, we cannot stop for atleast 20 chelation sessions, because of the expectation of massive re-equilibration of Gd 2-3 weeks after each chelation.

Whereas in most people who have symptoms, and it is not clear whether it is GDD or not, the definitive test for it is chelation with Ca-DTPA, pre- and post-chelation 24 hr urine for heavy metals (to look for Gd [and other heavy metals] and to see if they elevate considerably in post-chelation urine, while simultaneously you experiencing Flare) and looking for early Gd removal Flare, and late Gd re-equilibration Flare; in your case this may be dangerous if we don't follow through with atleast 20 chelations. Then we also have to consider the background of MS in you, and you also describe Covid Long Haul.

If they can do future MRIs without GBCA, or with fewer GBCA injections, this may be prudent. If the non MS skin burning then becomes very problematic, either now, prior to future GBCAs, or after the next GBCA injection, we will have to look at biting to bullet with multiple chelations, and also avoiding all future GBCA injections. We won't consider this unless we have to.

This following was not part of the communication. with possible GDD symptoms after 1 - 2 GBCA injections for evaluation of MS, the downside of severe re-equilibration Flare from chelation would not be an issue and therefore would not outweigh the potential benefit.

Richard Semelka, MD