Question: I have been diagnosed with "white matter disease" and have been told that it is quite common and nothing can be done. The neurologist is not sure if it is multiple sclerosis or something else.

I keep getting sent back and forth to different doctors, but no one wants to be the one to officially diagnose my condition. I also have diabetes. What is white matter disease, and what do you suggest?

Dr. Hibberd's Answer

White matter disease often refers to scarring changes seen on brain imaging in the outer sections of each side of the brain called the cortex. Do not lose focus by a lack of diagnosis. Sometimes the diagnosis is not clear until an investigation is complete.

Though an accurate diagnosis is a good guide to appropriate treatment and management, sometimes the label is not as important as the realization of the process and setting up a risk-management schedule with your neurologist and your consulting physicians to minimize further degenerative changes.

Each section of brain cortex has specialized functions, so disabilities, if any, will vary widely according to the nature, number, and location of these scars (referred to as white matter disease). The CTT scans and the more elaborate MRI scans are very useful at locating them.

There are many causes of white matter disease, and, of course, management will depend upon the severity and extent of disease present, and the risk of disability anticipated in the future.

Many diabetic patients have scarring as a result of small-vessel disease and local tissue damage, which can be caused by degenerative changes as well as aging or even mini-strokes. Multiple sclerosis and other de-myelinating diseases have characteristic patterns that may be also seen as white matter disease. Numerous neurodegenerative diseases produce white matter changes as does regular aging of brain tissue.

See your primary care physician for a simple explanation, and ask what can be done to investigate further, minimize, or prevent further white matter changes. Ask if these are age-related or related to vascular or degenerative disease that may need further evaluation.

If you get insufficient answers, I recommend you consult a large hospital for further evaluation. Be sure to ask for aggressive control of your diabetes and an assessment of your risk for vascular disease.