Multiple sclerosis (MS) causes damage, called lesions, to parts of the central nervous system, including the spine.
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
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.
Yoon BN, Ha CK, Lee KW, Park SH, Sung JJ. A confusing case of multiple sclerosis and central nervous system graft versus host disease. Korean J Intern Med. 2016;31(5):995-998. doi:10.3904/kjim.2015.065
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.
CAVALLINI JAMES/BSIP SA/Alamy Stock Photo
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 neuromyelitis 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.
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.
What do lesions on the spine mean with MS?
MS causes the immune system
How serious are lesions on the spine?
Spinal lesions may lead to worse neurological outcomes for a person with MS. They can also cause symptoms such as pain, numbness, and difficulty walking.
Are spinal lesions treatable?
There is no cure for MS spinal lesions. However, doctors may use injectable or oral treatments to slow progression and relieve the symptoms of spinal lesions.
What do MS spinal lesions feel like?
MS spinal lesions may cause numbness, itching, pain, or tingling.
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.