Multiple sclerosis (MS) causes damage, called lesions, to parts of the central nervous system.
MS is a neurological disease. It causes the immune system to attack and destroy myelin — protective fatty tissue that surrounds nerve cells.
This process, called demyelination, forms lesions in areas of the central nervous system, including parts of the brain and spinal cord.
This article reviews the link between multiple sclerosis and spinal lesions.
MS is an autoimmune disorder that affects the central nervous system. It causes the immune system to attack the protective layer of fat, called the myelin sheath, around nerve cells in the brain and spinal cord.
This slows down the nerves’ impulses, causing symptoms that may either worsen steadily (known as progressive) or come and go (known as relapsing-remitting).
The body may never fully repair the damage, which can lead to
. Damaged areas, called lesions, can occur in parts of the brain and spinal column.
Some people with MS have a stable condition, others experience symptoms that worsen rapidly, while some have symptoms that resolve spontaneously.
A person living with MS
Doctors use various techniques to diagnose MS, including MRI scans and neurological exams.
They
A contrast MRI can help doctors discover if there are active lesions. These types of tests can help them determine if the lesions fit the criteria for diagnosing MS.
On their own, no symptoms, physical findings, or laboratory tests can point to MS.
For a doctor to diagnose the disease, they must find:
- evidence of damage in at least two areas of the central nervous system — including the brain, spinal cord, or optic nerves
- evidence that the damage occurred in different areas at different times
- no indication that other issues, such as an infection or stroke, caused the lesions
In some cases, a person may have lesions on the brain or spinal cord before a diagnosis of MS. Both radiologically isolated syndrome (RIS) and clinically isolated syndrome (CIS) can involve lesions on the brain or spinal cord similar to MS.
RIS
About 50% of people diagnosed with RIS go on to develop MS within 10 years. RIS does not have any symptoms and doctors do not consider it to be a cause of MS.
By contrast, about 60–80% of people diagnosed with CIS who have lesions on the brain go on to develop MS. Unlike RIS, CIS is both a cause of MS and involves a neurological symptom due to inflammation of the central nervous system.
What do MS lesions look like on an MRI scan?
MS lesions may appear as either areas of gray, white, or black spots on an MRI, depending on whether they are new or old. The lesions are often oval or frame-shaped.
A doctor will look at all areas of the brain because the lesions can appear on either white or gray matter.
In order to better see the lesions, a doctor may use gadolinium, which is a contrasting dye. The dye helps the doctor to see the presence of active inflammation, or it
Learn more about MRI and MS here.
What do MS lesions on the spine look like?
According to a
Similar to lesions found on the brain, they can appear as areas of bright or dark spots on the spinal cord.
What is nuromyelitis optica?
Neuromyelitis optica, or Devic’s disease, is another demyelinating condition of the spine and optic nerve. In its early stages, it can be easily mistaken for MS due to similarities in symptoms. Both conditions can cause: myelitis — swelling and inflammation on the spinal cord; and optic neuritis — inflammation of the optic nerve that disrupts vision.
Doctors can use distinguishing features of neuromyelitis optica to rule out MS or vice versa. Signs of vision loss or other symptoms that may be the result of neuromyelitis optica include:
- both spinal cord and optic nerve swelling that is more severe
- a normal MRI of the brain
- impact on vision affecting both eyes (with MS, only one eye is usually affected)
- proteins called oligoclonal bands not present in the spinal fluid (they are usually present in cases of MS)
Lesions on the spine and brain indicate damage to the myelin that protects nerve cells. This is a sign of MS.
One function of myelin is to help the nerves send impulses. Without myelin, the nerves’ impulses travel more slowly.
In a
They demonstrated that people with primary progressive MS have more spinal cord lesions than brain lesions. The researchers also noted that those with more spinal cord lesions experienced greater physical disability.
In addition, the findings suggest that spinal cord involvement predicts worse neurological outcomes. The researchers also observed impaired repair mechanisms and recurrent demyelination in the spinal lesions.
A person’s symptoms depend on where MS lesions develop.
According to the National Multiple Sclerosis Society, symptoms of MS include:
- pain and itching
- numbness or tingling
- weakness
- fatigue
- dizziness and vertigo
- sexual dysfunction
- trouble walking
spasticity - vision problems
- bladder problems
- bowel problems
- behavioral and learning difficulties
- depression
Less common symptoms include difficulties speaking, swallowing, and breathing.
Also, some people living with MS experience electrical sensations running through their spine and limbs.
No two people have the same combination of MS symptoms. Also, a person’s symptoms can change from day to day or from flare-up to flare-up.
Doctors can prescribe steroids to help reduce inflammation, which may reduce symptoms. However, this is not a cure, and it cannot prevent the symptoms from returning.
Another goal of MS treatment is to prevent further damage to nerve cells. Injectable, oral, and infusion medications can help slow the progression of the disease.
Some injectable treatments include interferon beta-1a, interferon beta-1b, and glatiramer acetate. Oral treatments include teriflunomide, fingolimod, and siponimod. Infusion medications include Tysabri, Ocrevus, and Lemtrada.
(Video) Neuroscience Updates Online - Fall 2020 - Multiple Sclerosis: Pathogenesis, Diagnosis, & Treatment
Anyone who believes that they are experiencing any symptoms of MS should see a doctor. Initial symptoms could involve unexplained weakness and sensory changes.
Receiving treatment early on could slow the progression of MS.
People experiencing mild flare-ups may not require medical attention as the symptoms could go away without treatment. However, anyone with more severe symptoms should see a doctor.
The following are answers to some commonly asked questions.
Can you have MS without lesions on the spine?
It is possible that a person may not have lesions on either the spine or brain during their initial diagnosis. However, the longer a person goes without developing a lesion, the more important it is for a doctor to rule out other conditions.
What are the symptoms of MS lesions on the cervical spine?
The cervical region is the upper part of the spine found in the neck. MS lesions on the cervical spine can cause similar symptoms to when they appear in other areas, such as numbness, weakness, and balance issues.
In addition, they can cause loss of sensation in both the shoulders and arms. For some, lesions on the cervical spine can lead to paralysis in all limbs.
What causes MS lesions?
MS causes the immune system
Can you have MS lesions on the brain but not the spine?
It is possible that a person diagnosed with MS may have lesions on their brain but not on their spine. The opposite is also true. To avoid misdiagnosis, a person’s doctor
Multiple sclerosis is a complex disorder that involves the immune system attacking the protective coating of nerves, forming areas of damage called lesions.
A person living with MS may have lesions in parts of the brain, spinal cord, or optic nerve. Limited research suggests that having these lesions on the spine may lead to worse neurological outcomes of MS.
Symptoms of MS can differ from person to person and from day to day. A range of medications can help slow the progression of the disease, but there is no cure for MS yet.
FAQs
Can you have MS with only spinal cord lesions? ›
Spinal cord lesions are common in MS. They're found in about 80 percent of people newly diagnosed with MS. Sometimes the number of spinal lesions identified from an MRI can provide the doctor with an idea of the severity of the MS and the likelihood of a more serious episode of demyelination occurring in the future.
What is the treatment for a lesion on the spine? ›The treatment of a spinal lesion varies by the underlying cause. Among the examples: Infections may be treated with antibiotics, antifungals, or antiviral drugs. Inflammatory conditions may be treated with anti-inflammatory drugs, steroids, or immunosuppressant drugs.
What do MS lesions on spine cause? ›MS lesions on the cervical spine can cause similar symptoms to when they appear in other areas, such as numbness, weakness, and balance issues. In addition, they can cause loss of sensation in both the shoulders and arms. For some, lesions on the cervical spine can lead to paralysis in all limbs.
How many lesions do you have to have to be diagnosed with MS? ›Traditionally, the diagnosis of MS depends upon showing that there is sclerosis (scarring or inflammation) that is multiple–patients must have two separate CNS lesions that have occurred in two or more separate episodes, which is to say they must have lesions disseminated in space and in time.
How is sclerosis of the spine treated? ›There is no known cure for spinal sclerosis, but there are treatments that can prevent the disease from progressing. Physical therapy exercises, and prescription medications can help patients with muscle control issues and associated pain.
What symptoms do spinal lesions cause? ›- Pain;
- Weakness in shoulders and wrists:
- Loss of bicep jerk reflex:
- Horner Syndrome; and.
- Paralysis in the hands and legs.
Typically, the treatment goal in benign spine lesions is definitive cure. Painful benign spine lesions commonly encountered in daily practice include osteoid osteoma, osteoblastoma, vertebral hemangioma, aneurysmal bone cyst, Paget disease, and subacute/chronic Schmorl node.
Is a spinal lesion serious? ›Spinal tumors or growths of any kind can lead to pain, neurological problems and sometimes paralysis. A spinal tumor can be life-threatening and cause permanent disability. Treatment for a spinal tumor may include surgery, radiation therapy, chemotherapy or other medications.
How common are spinal lesions? ›Primary spinal tumors, which begin in your spine, are uncommon. Benign (noncancerous) primary spinal tumors account for 0.5% of all newly diagnosed tumors. Malignant (cancerous) primary spinal tumors are even less common.
How common are MS lumbar spine lesions? ›This damage leaves behind scar tissue that forms into lesions on the brain or spinal cord called plaques. Spine lesions are common in people with MS. One study found that in 104 people recently diagnosed with MS, 83 percent had spine lesions.
How many lesions is alot for MS? ›
An “average” number of lesions on the initial brain MRI is between 10 and 15. However, even a few lesions are considered significant because even this small number of spots allows us to predict a diagnosis of MS and start treatment.
Are spinal lesions permanent? ›A spinal cord injury — damage to any part of the spinal cord or nerves at the end of the spinal canal (cauda equina) — often causes permanent changes in strength, sensation and other body functions below the site of the injury.
Where are most MS lesions found? ›MS can cause a wide variety of neurologic symptoms since it can affect numerous areas of the brain, optic nerve, and spinal cord (Figure 3). Characteristic lesions are located in the periventricular and juxtacortical regions, in addition to the brainstem, cerebellum, spinal cord, and optic nerve.
Why is Benadryl great for multiple sclerosis? ›Some people with multiple sclerosis (MS) may be given diphenhydramine (Benadryl) before undergoing certain treatments. Preventive use of this antihistamine can help you avoid adverse effects, such as allergic reactions to infusions.
How accurate is an MRI for diagnosing MS? ›MRI has greater than 90% sensitivity in the diagnosis of MS; however, other white matter diseases can sometimes have a similar appearance on medical imaging.
What is the most effective multiple sclerosis treatment? ›Treatments to modify progression. For primary-progressive MS , ocrelizumab (Ocrevus) is the only FDA-approved disease-modifying therapy (DMT). Those who receive this treatment are slightly less likely to progress than those who are untreated.
What are 3 drugs to treat multiple sclerosis? ›- Lemtrada® (alemtuzumab)
- Novantrone® (mitoxantrone)
- Ocrevus® (ocrelizumab)
- Tysabri® (natalizumab)
In MS (a), MRI shows areas of T2 hyperintensity which extend for a single vertebral level, involve both grey and white matter in the lateral-posterior part of the cord and have a cylindric shape on the sagittal view and a wedge shape on the axial view.
Where are most MS lesions found? ›MS can cause a wide variety of neurologic symptoms since it can affect numerous areas of the brain, optic nerve, and spinal cord (Figure 3). Characteristic lesions are located in the periventricular and juxtacortical regions, in addition to the brainstem, cerebellum, spinal cord, and optic nerve.
Can you have a clear MRI and still have MS? ›Although MRI is a very useful diagnostic tool, a normal MRI of the brain does not rule out the possibility of MS. About 5 percent of people who are confirmed to have MS do not initially have brain lesions evidenced by MRI.
What kind of lesions are associated with MS? ›
In MS, patients develop various areas in the brain and spinal cord where the myelin is stripped off of the nerves. These areas are called plaques or sometimes lesions. When the myelin is off, the electrical conduction of these nerves is altered. It is like getting a fuzzy signal on a television set.
Can you have MS without demyelination? ›Now, new study findings have identified a subtype of MS—myelocortical MS (MCMS)—that has neuronal loss but no demyelination of the brain's white matter.
What does MS in the spine feel like? ›Many with spinal cord problems and MS have numbness on one side of the body and weakness on the opposite side. They may lose standing balance or have a gait problem characterized by ataxia, such as the inability to walk a straight line. Paralysis and loss of sensation of part of the body are common.
What does MS look like on MRI of spine? ›In MS (a), MRI shows areas of T2 hyperintensity which extend for a single vertebral level, involve both grey and white matter in the lateral-posterior part of the cord and have a cylindric shape on the sagittal view and a wedge shape on the axial view.
What is the strongest known risk factor for MS? ›The strongest known risk factor for MS is infection with Epstein-Barr virus (EBV). Compared with uninfected individuals, the hazard of developing MS is approximately 15-fold higher among individuals infected with EBV in childhood and about 30-fold higher among those infected with EBV in adolescence or later in life.
What illness is similar to MS? ›- Epstein-Barr Virus.
- Vitamin B12 Deficiency.
- Diabetes.
- Nerve Damage.
- Eye Problems.
- Stroke.
- Lupus and Other Autoimmune Diseases.
- Parkinson's Disease.
Will MS brain lesions go away? It might be possible to one day heal lesions in addition to slowing the growth of them. Scientists are working to develop myelin repair strategies, or remyelination therapies, that might help regrow myelin.
How many lesions is alot for MS? ›An “average” number of lesions on the initial brain MRI is between 10 and 15. However, even a few lesions are considered significant because even this small number of spots allows us to predict a diagnosis of MS and start treatment.
How do you know if MS is progressing? ›It's also common early on in the disease to experience long intervals between relapses. Later, as MS progresses, people may have difficulty with tremors, coordination, and walking. They may find that their relapses become more frequent, and that they are less able to recover from them.
What does it mean when MS lesions are active? ›A so-called active lesion represents an area of ongoing inflammation in which the immune system is currently attacking the myelin sheath.
Does MS make your neck hurt? ›
Neck and back pain: Some people with MS can experience neck and back pain. This may be due to immobility, or to the same type of wear and tear that many people without MS experience. This type of pain is often an aching, stiff sensation that can be moderately severe.
Can spine problems mimic MS? ›Spinal Disorders
This irritation of nearby nerves can lead to numbness or weakness in the area of the body that correlates with the affected nerves. These symptoms can mimic those of MS.
Overview. People living with MS often continue working long after their diagnosis. On the flip side, some people with MS decide to leave their jobs when they are first diagnosed or experience their first major exacerbation, often at the suggestion of their family or doctor.
Can you drive with MS? ›One of the first questions many people have when they're diagnosed with MS is: “Will I still be able to drive?” The good news is that most people with MS continue to drive as normal.