What to Know About Lesions and MS

Multiple sclerosis (MS) is an autoimmune disease. For people with MS, the immune system mistakenly attacks the protective covering on nerve fibers. This covering is called myelin.¹

The attacks by the immune system lead to the formation of lesions in the central nervous system (CNS). Lesions are areas of damage or inflammation.¹

What are lesions?

The myelin sheath is a layer around the nerves. It allows for efficient transmission of signals between the brain, spinal cord, and the rest of the body. When the myelin is damaged, the nerve signals become disrupted and neurons can degenerate. This can lead to various MS symptoms.^1,2

A lesion is a damaged or scarred area. In MS, they are caused by the inflammation from the immune system attacking the myelin. Lesions are sometimes called plaques. Not all lesions in the CNS are caused by MS. But lesions are an important sign of MS. Doctors use the presence and location of lesions to help diagnose and track MS.^1,2

MS lesions can occur throughout the CNS, including the brain, spinal cord, and optic nerves (the nerves that transmit signals from the eyes). Lesions are caused by focal inflammation that results in damage to the myelin and nerves. This damage ultimately leads to scar tissue. Lesions can vary in size and location. Lesions can be detected with imaging techniques such as magnetic resonance imaging (MRI).

What do lesions look like on MRI scans?

Doctors use MRI scans to look for lesions. In MS they often use an MRI scan with contrast. This means they inject a contrast fluid that contains gadolinium. The gadolinium shows up white (“lights up”) on certain MRI sequences where inflammation is happening. So, doctors look for white patches on these MRI sequences to detect active lesions with inflammation. Lesions older than 3 months typically will not light up with gadolinium.

While gadolinium only highlights newer lesions with ongoing inflammation, other MRI sequences can reveal all lesions, new or old, without any gadolinium. Combining these different MRI techniques allows doctors to identify both newer active and older inactive lesions.

Over time, some lesions may show up as a black spot on some MRI sequences. This means the CNS tissue has suffered so much damage that it completely degenerates or disappears. Some lesions have been shown to grow slowly over time. These are called chronic active lesions or smoldering lesions. Research shows that smoldering lesions may be a risk factor for progressive MS.

How are lesions used to diagnose and monitor MS?

Lesions play an important role in the diagnosis and monitoring of MS. Diagnosing MS often involves imaging, like an MRI, to look for signs of damage in the CNS. But MS is not the only cause of lesions. Radiologists review every MRI and look for signs of diseases. An MRI report may include lists of all possible conditions that could explain the results.

An MRI with lesions does not mean you definitely have MS. For a final MS diagnosis, a doctor will typically use a physical exam and questions about your medical history. They may confirm the diagnosis or rule out other conditions with other tests like bloodwork or a spinal tap.

If you are already diagnosed with MS, your doctors may use MRI images to look for evidence of ongoing disease activity such as new lesions. Current MS disease modifying therapies help prevent development of new lesions. New lesions on an MRI might suggest your current therapy is not working for you. MRIs taken over time can also show changes in old lesions. Sometimes old lesions can shrink or fade overtime. If lesions are growing or spreading, it may mean you need to consider new treatments.

If you are getting multiple MRIs over time of the same area of your body, try to get the MRIs at the same facility. This helps with tracking because the MRI machine and technique will be more consistent.

You may have access to MRI results before meeting with your doctor. But it can be a good idea to wait to review results with a professional. Doctors are trained to interpret the results and can address any concerns you may have.

 

 From: https://multiplesclerosis.net/clinical/what-are-lesions?utm_confid=32f64fac94bd683a885744accd9fcdfdb16ae862446753ab1f7cc160d11f8d21&utm_term=Article_1_Button&utm_source=ActiveCampaign&utm_medium=email&utm_content=Understanding%20MS%20Lesions&utm_campaign=MultipleSclerosis%20net-Newsletter-10%2F19%2F2023

 

Can Vitamin D Help MS?

 By Stephanie Watson

You might have heard that vitamin D helps to lower the risk for multiple sclerosis (MS). Or that it helps lessen symptoms in people who already have the disease. Evidence suggests that getting enough of this vitamin might protect against MS by holding back your immune system from attacking your own nerve cells.

But the link between vitamin D and MS isn't proven yet.

The MS-Vitamin D Link

This fat-soluble vitamin acts like a hormone in your body. Vitamin D also helps your immune system work better and to tamp down inflammation.

Those protective actions are important in autoimmune diseases like MS where your body turns against itself. In MS, cells of your immune system attack the coating around nerve fibers, called myelin, and leads to such hallmark symptoms as numbness, weakness, and blurry vision.

Research finds that vitamin D might help repair myelin and guards your nerves from damage.

Can Vitamin D Prevent or Slow MS?

Researchers aren’t sure if vitamin D can keep you from getting MS in the first place. Your body makes most of the vitamin D it needs from sunlight on your skin. People in northern climates like Scotland and Scandinavia are more likely to have MS compared with those who live in much sunnier climates. Studies show that people who get more sunlight and more vitamin D in their diets have a lower risk for MS overall.

There's some evidence that vitamin D might slow MS and make the disease less severe. Studies have found a link between higher vitamin D levels in the blood and less active disease, fewer lesions in their brain and spinal cord, and fewer relapses of symptoms.

In other studies, people with MS who had higher vitamin D levels had less severe disease and disability.

Do I Need More Vitamin D?

It's common for people with MS to be low on this vitamin. It may be hard for you to get outside to get sun often enough. Low vitamin D can also be a side effect of corticosteroids and other MS medications.

Your doctor can run a blood test to check your vitamin D level. You might be able to make up the difference by eating more fatty fish, eggs, and other foods that are high in vitamin D. Or, your doctor might suggest you take a supplement.

It's not clear whether taking a daily vitamin D supplement protects people from getting MS, or slows the disease in those who already have it. Studies suggest it might help, but this hasn't been proven. But since supplements are usually safe to take, it may not hurt to try them.

What Dosage Is Best?

Experts can’t say how much vitamin D is needed to prevent or slow MS. Different medical groups disagree on the ideal amount.

Official recommendations for adults is 400 to 600 international units (IUs) of vitamin D daily.

Ask your doctor what’s right for you. Be careful not to overdo it. Vitamin D helps your body absorb calcium, and you might end up with too much of that mineral. High calcium levels can weaken bones, damage the heart, and increase the risk for kidney stones.

If you already have MS, your doctor can check whether your vitamin D levels are too low. If so, it might make sense for you to take a supplement.

 

Inside An MS Exacerbation

By Devin Garlit · 

Exacerbation, relapse, flare-up, attack: these are all names for the same thing with regard to Multiple Sclerosis. The general definition of this event is the occurrence of new or worsening of old symptoms lasting for more than 24 hours and taking place at least 30 days after a similar event. While this can be standard occurrence for those with Multiple Sclerosis, not everyone actually understands what’s going during this period. Understanding what is happening during an exacerbation is critical for those with MS. With that in mind, I’ll do my best to help break it down as simply as I can.

What’s happening to the body during an MS exacerbation?

During one of these moments, the disease has caused your own immune system to attack your body. Specifically, your immune system begins to assault your central nervous system. Its weapon of choice? Inflammation (caused by various immune cells). This inflammation damages myelin, a fatty substance that surrounds and helps insulate our nerves. This insulating layer makes sure our nerves properly conduct the electrical signals that our brain sends to the other parts of our body (think of it as the plastic covering on an electrical wire). When this layer is damaged, those signals don’t move fast enough or at all, which is where we start to see our symptoms. Can’t lift your leg fast enough or at all? The myelin around a nerve between your brain and leg has been compromised and the signal isn’t traveling as efficiently as it should be. Not only does our immune system damage the myelin, but it also damages the cells needed to regrow it.

When the immune system attacks

These moments that we call exacerbations (or whichever term you like) are when the immune system is making its attack. It’s when the immune system has created a lot of inflammation in your central nervous system, and it’s damaging that myelin layer. Not only does this inflammation damage that protective coating, but it also has an effect on those signals that are traveling through that part of the central nervous system. We use steroids to fight exacerbations as they help to reduce this inflammation.

When a relapse is over: the aftermath

When an exacerbation is over, these damaged areas of myelin develop some scar tissue (that’s where we get the term sclerosis in multiple sclerosis, we are left with multiple scars; these scars are also referred to as plaques or lesions). Once all that inflammation is gone or significantly reduced, some of that myelin can regrow, but it never grows back completely or strong enough due to the scarring and because the cells needed to facilitate regrowth have been damaged. This regrowth, coupled with the reduction in inflammation, is why people can seem to bounce back after an exacerbation. They may even seem like they are completely well again. That’s why people often use the term “relapse,” because they seem to improve or go back to the way they were. This is a pattern that is extremely common in people diagnosed with the Relapsing-Remitting form of the disease. However, the more exacerbations you have, the more your ability to bounce back becomes hindered.

Accumulating damage over time

The more scars you have and the more cells that help regrow myelin are damaged, the less you are able to recover. In the past, maybe a damaged nerve could still get the brain’s signal where it needed to go, even if not the most efficiently (unless an outside influence temporarily triggered an issue). As more damage occurs over time though, the ability of that nerve to do its job, no matter the situation, becomes compromised. Basically, that’s how people with MS can worsen over time. That’s why doctors try to not only shorten the length of exacerbations through steroids, but to minimize the overall number of them with disease-modifying drugs.

Zinbryta (daclizumab), a Therapy for Relapsing MS, is Withdrawn from Market

• Biogen and AbbVie have announced the voluntary withdrawal Zinbryta ™ (daclizumab) from the worldwide market.
• Zinbryta is an immune-modulating therapy that was approved in 2016 for people with relapsing MS and generally reserved for people who had an inadequate response to two or more MS therapies.
• According to a company press release, the European Medicines Agency had raised new safety concerns related to reports of inflammation of the brain or its surrounding tissues (inflammatory encephalitis and meningoencephalitis) among people taking Zinbryta.
• Individuals currently taking Zinbryta should contact their healthcare providers to determine alternative treatment options, and to continue safety monitoring. According to the medication guide, this would include monthly blood tests to monitor liver function for up to six months after the last dose.