Multiple sclerosis (MS) is a condition that can affect the brain and spinal cord, causing a wide range of potential symptoms, including problems with vision, arm or leg movement, sensation, or balance. It's a lifelong condition that can sometimes cause serious disability, although it can occasionally be mild.
New research indicates that the brain and spinal cord scars in people with MS may offer clues to why they develop progressive disability but those other autoimmune diseases.
Inflammation leads to permanent scarring in these three diseases:
"The differences in scarring that we found will help physicians distinguish these three diseases more easily to aid in the diagnosis," says Eoin Flanagan
In all three of these diseases, the immune system attacks the myelin, the insulation covering the nerves. This leads to inflammation and removal of the myelin, called demyelination, within the brain and spinal cord. Visual problems, numbness, weakness, or bowel or bladder dysfunction are common symptoms.
Areas of demyelination, known as lesions, appear as white spots on an MRI. The repair mechanism in the body tries to repair and heal the lesions, but it’s left unfinished, leading to a scar that remains visible on future MRIs. Given that in MS the scars are located in the brain and spinal cord that control arm and leg muscles, nerve fibers can degenerate and lead to a slow worsening of disability in the secondary progressive course of MS.
With AQP4-NMOSD (neuro meyelitis optica ), large areas of inflammation mostly occur during attacks, which often results in severe symptoms. Scars are common, but they tend to be smaller and in less important locations than in MS. Thus, fewer long-term problems result from those scars.
With MOGAD ( myeline oligodendrocyte glycoproteine antibody disorder ) , large areas of inflammation which occur during an attack, lesions have a tendency to disappear completely in a short period of time without leaving any scars. This fits well with the excellent recovery from episodes and overall good long-term prognosis without the slow worsening disability seen in MS.
The reasons behind this recovery are incomprehensible, the researchers note. It may imply an enhanced ability to put the covering back onto nerves, or demyelination.
"We hope that the improved understanding on the ways MOGAD ( myeline oligodendrocyte glycoproteine antibody disorder ) repairs its lesions so well may lead to novel treatment avenues to prevent scar formation in MS," Dr. Flanagan says.