Spinal cord volume loss: A marker of disease progression in multiple sclerosis.Tsagkas C, Magon S, Gaetano L, Pezold S, Naegelin Y, Amann M, Stippich C, Cattin P, Wuerfel J, Bieri O, Sprenger T, Kappos L, Parmar K.Neurology. 2018 Jun 27. pii: 10.1212/WNL.0000000000005853.
Patients with SPMS had lower baseline SCV (p < 0.01) but no accelerated SCV loss compared to those with RRMS.
SPMS is associated with more nerve loss
Clinical relapses were found to predict SCV loss over time (p < 0.05) in RRMS.
Relapses are not good for your nerves…don’t have them
If you are having them on treatment…time to talk to your neurologist and think about changing to something more active.
Furthermore, SCV loss, but not total brain volume and T2 lesion volume, was a strong predictor of EDSS score worsening over time (p < 0.05).
Loss of nerves in the spinal cord is a prediction of whether you will lose leg function. This is not surprising as the spinal cord is the nervous highway from your brain to your legs; you go slower if more lanes are closed on that highway.
The mean annual rate of SCV loss was the strongest MRI predictor for the mean annual EDSS score change of both RRMS and SPMS separately, while correlating stronger in SPMS.
If you are losing nerves, your cord may shrink, but remember that you can still be losing nerves when your spine doesn’t shrink because the space is being filled by glial and fluid. The faster it shrinks the more likely you are to lose lower limb function and this is better predicted in progressive MS. This may because it is not confounded by swelling due to inflammation which is more common in relapsing MS.
The more the spinal cord shrinks the greater the chance of progression.
A dermatome is an area of skin supplied by sensory neurons that arise from a spinal nerve ganglion. Symptoms that follow a dermatome (e.g. like pain or a rash) may indicate a pathology that involves the related nerve root. Referred pain usually involves a specific, “referred” location so is not associated with a dermatome.