When Multiple Sclerosis Attacks the Spinal Cord

Lesions in the spinal cord often result in an increased risk of disability. A study published in 2021 looked at a large group of relapsing and progressive MS patients and found that asymptomatic spinal lesions were seen in about 15 percent of clinically stable MS patients over a median period of 14 months. According to the study authors, the presence of these lesions indicated an increased risk of future brain and spinal cord lesions that may contribute to worsening disability over time.

However, another study found that among several different areas of the brain and spinal cord, only atrophy (caused by lesions) in the very top area of the spinal cord was significantly associated with a greater level of self-reported disability. Even so, no specific areas of atrophy or lesions were associated with better or worse performance on a timed 25-foot walking test.

Developing Potential Therapies for MS

In 2017, the U.S. Food and Drug Administration (FDA) approved ocrelizumab (Ocrevus) to treat adults who have relapsing forms of multiple sclerosis and primary progressive multiple sclerosis (PPMS). It was the first drug approved by the FDA for PPMS. “Ocrevus had the most effect in the first several months, but the modest benefit persisted over time,” says Reder.

But Reder says it remains to be seen whether any therapy can help slow or halt the accumulating spinal cord lesions that affect some people with progressive MS and that are very difficult to treat.

“Any therapy that has prolonged effects on slowing of progression in MS,” he says, “would be a big breakthrough.”