The nervous system is divided into two parts: the central nervous system (brain and spinal cord) and the peripheral nervous system (all nerves after they have exited the brain and spinal cord). Multiple Sclerosis (MS) is an autoimmune disorder that attacks the central nervous system along the myelin sheath (the protective coating on the outside of the nerve cells), leaving scars that cause symptoms that accumulate over time to cause increasing disability in cognition, motor function, ambulation, balance, and more.
Approximately 80 percent of people with MS develop spinal cord symptoms, and, because the spinal cord is quite a small rope with many nerve fibers packed tightly within, it may cause some of the most significant symptoms. Further, while many lesions in the brain may accumulate silently, almost all spinal cord lesions cause new symptoms. The brain has more of an ability to compensate for the damage, and symptoms arising from lesions in the spinal cord tend to last longer or become permanent.
The spinal cord is comprised of three portions: the cervical cord, the thoracic cord, and the lumbar spine. Attacks on the cervical spine (the upper part of the spine) account for about 60 percent of spinal lesions in MS. The remainder occur in the thoracic spine (from base of neck to mid-back). The spinal cord ends at the very first lumbar vertebra (bone), and so lesions in the lumbar spine are very rare.
There are other immune-related conditions that cause spinal lesions similar to those in MS, including Neuromyelitis optica, acute transverse myelitis, lupus, certain infections, and MOG antibody-associated disease (MOGAD). Doctors make the distinction by the pattern of the lesions, along with bloodwork and sometimes spinal fluid examination. It is imperative that the correct diagnosis is made as the treatment is different for each of these conditions. Such differentiation requires great expertise and may require evaluation by an MS expert.
The most common symptoms from spinal cord lesions include difficulty walking, difficulty with balance, tremors, bladder issues (such as incontinence and difficulty emptying the bladder), and bowel problems.
MRI scans remain the main method of diagnosing MS and detecting lesions in the brain and spinal cord. Lesions may show up before any symptoms are detected (called radiologically isolated syndrome or RIS). Patients with lesions detected in the spinal cord are more likely to have MS relapses, develop disability, and need to switch to the most effective therapies.
There are currently more than 20 FDA-approved Disease-Modifying Therapies. That can reduce the relapse frequency and severity. Moreover, there are other medications used in MS to improve symptoms. It is of utmost importance that the diagnosis of MS, in the brain and/or the spinal cord to start therapy early to prevent worsening disability.
BeCare MS App can help by monitoring your neurologic exam over time and recording your symptoms. If you detect worsened neurologic function, you can be proactive by working with your doctor to find the most appropriate treatments to protect your neurologic health. Be empowered. Become a driver in your own MS journey. Be Aware with BeCare.