Spinal cord lesions in multiple sclerosis: imaging and treatment monitoring

In multiple sclerosis (MS), the body's own immune system damages the nervous system. Spinal cord lesions occur in ~80% of patients and strongly influence disability, but are more difficult to image with MRI than brain lesions due to the small diameter of the spinal cord and physiological motion (e.g. breathing, cardiac activity). There are important differences between the brain and spinal cord in terms of anatomy, immune environment and the barrier with the blood. This means that findings from brain research cannot be directly applied to the spinal cord.
A notable finding from this thesis is that more aggressive MS medications, which effectively reduce brain lesions and relapses, do not appear to offer a clear advantage over less aggressive medications in preventing spinal cord lesions. This raises the question of whether some patients may require a different treatment approach.
It also remains unclear which patients need more frequent spinal cord MRI follow-up. Antibody levels measured from cerebrospinal fluid did not prove to be a useful predictor for this. The ongoing MSpine study should clarify whether routine spinal cord MRI is beneficial in certain patients.