Multiple sclerosis (MS) causes a specific type of damage, called demyelination, to the central nervous system, including the spinal cord.

MS is a neurological disease. It causes the immune system to attack and destroy myelin, a protective fatty tissue surrounding nerve cells.

This process, called demyelination, affects the function of the central nervous system, including parts of the brain and spinal cord.

This article reviews the link between MS and spinal cord demyelination.

A woman sitting at kitchen table and serving herself food.Share on Pinterest
Clique Images/Stocksy

MS is an autoimmune disorder that affects the central nervous system. It causes demyelination, where the immune system attacks the myelin sheath, a protective layer of fat around brain and spinal cord nerve cells.

This prevents the nerves from sending impulses or messages, causing symptoms that may worsen steadily (known as progressive MS) or come and go (known as relapsing-remitting MS).

The body may never fully repair the damage due to demyelination, leading to scarringTrusted Source. Damage from demyelination can develop in the brain and spinal cord. When a damaged area is visible on a scan, it is known as a lesion.

Sometimes, people with MS remain in a stable condition, others experience symptoms that worsen rapidly, while some have symptoms that resolve spontaneously.

A person living with MS could experience a broad range of symptoms based on the number, location, and severity of the damage from demyelination. They can include vision issues, cognitive impairment, sensory problems, and mobility issues.

Doctors use various techniques to diagnose MS, including MRI scans and neurological exams.

Scans oftenTrusted Source identify MS lesions in the periventricular white matter of the brain, the optic nerves, or the spinal cord.

A contrast MRI can help doctors identify any active lesions. These types of tests can also help them determine if the lesions fit the criteria for diagnosing MS.

Share on Pinterest
Images of MS Lesions on the spine, via x ray. Image Credit: Yoon BN, Ha CK, Lee KW, Park SH, Sung JJ. A confusing case of multiple sclerosis and central nervous system graft versus host disease. Korean J Intern Med. 2016;31(5):995-998. doi:10.3904/kjim.2015.065

On their own, no symptoms, physical findings, or laboratory tests can definitively diagnose MS.

For a doctor to diagnose MS, they must find:

  • Evidence of demyelination in at least two areas of the central nervous system — including the brain, spinal cord, or optic nerves.
  • Evidence that the demyelination occurred in different areas at different times.
  • Find no indication that other issues, such as an infection or a stroke, caused the lesions.

Sometimes, a person may have demyelination on the brain or spinal cord before receiving a diagnosis of MS. Both radiologically isolated syndrome (RIS) and clinically isolated syndrome (CIS) can involve demyelination on the brain or spinal cord, similar to MS.

RIS causesTrusted Source demyelination in the brain or spinal cord. CIS causes numerous MS-like neurological symptoms that, in many cases, are precursors to the development of MS.

A 2020 articleTrusted Source reported that more than half of people diagnosed with RIS go on to develop MS within 10 years. RIS does not have any symptoms.

By contrast, about 60 to 80% of people diagnosed with CIS who have lesions on the brain go on to develop MS.

Learn more about diagnosing and testing MS.

What do MS lesions look like on an MRI scan?

MS lesions may appear as gray, white, or black spots on an MRI, depending on whether they are new or old and the type of MRI test used. The lesions are often oval or frame-shaped.

MS demyelination in the brain and spinal cord is much more common in the white matter, but it can also affect the gray matter.

Share on Pinterest
Demyelination on an MRI. Image Credit:
CAVALLINI JAMES/BSIP SA/Alamy Stock Photo

A doctor may use gadolinium, a contrasting dye, to better see the lesions. The dye helps the doctor identify the presence of active inflammation or increasesTrusted Source the sensitivity and specificity of the MRI scan.

What do MS lesions on the spine look like?

According to a 2019Trusted Source review, it can be difficult to image the spinal cord due to the potential for movement, such as breathing.

Lesions on the spinal cord can appear as white or dark spots similar to those found on the brain.

Learn more about MS and MRIs.

What is neuromyelitis optica?

Neuromyelitis optica (Devic’s disease) is another demyelinating condition of the spinal cord and optic nerve. In its early stages, a person might easily mistake it for MS due to similarities in symptoms. Both conditions can cause myelitis (swelling and inflammation of the spinal cord) and optic neuritis, which is inflammation of the optic nerve that disrupts vision.

It can be difficult to distinguish MS from neuromyelitis optica, but a few features may help distinguish these similar conditions. Signs of vision loss or other symptoms due to neuromyelitis optica include:

  • both spinal cord and optic nerve swelling that is more severe
  • a normal MRI of the brain
  • impact on vision affecting both eyes (MS usually only affects one eye)
  • absence of proteins called oligoclonal bands in the spinal fluid (they are usually present with MS)

Lesions on the spinal cord and brain indicate damage to the myelin that protects nerve cells, a sign of MS. One function of myelin is to help the nerves send impulses. Without myelin, the nerves cannot send messages.

In a 2018 study, researchers observed the patterns of lesions in the central nervous systems of people with either progressive or relapsing-remitting MS.

They found that people who had more spinal cord lesions were more likely to have worse outcomes.

A person’s symptoms depend on where MS lesions develop.

According to the National Multiple Sclerosis Society, symptoms of MS include:

Less common symptoms include difficulties speaking, swallowing, and breathing. Some people with MS may experience electrical sensations in their spine and limbs.

No two people with MS will have the same combination of symptoms, and symptoms can change from day to day or from flare-up to flare-up.

Learn more about the early signs and symptoms of MS.

During an MS flare, doctors can prescribe steroids to help reduce inflammation, which may reduce symptoms. However, this is not a cure and cannot prevent the symptoms from returning.

Another goal of MS treatment is to prevent further damage to nerve cells. Injectable, oral, and infusion medications can help slow the progression of the disease.

Some infusion treatments include interferon beta-1a, beta-1b, and glatiramer acetate. Some oral treatments include teriflunomide, fingolimod, and siponimod. Infusion medications include Tysabri, Ocrevus, and Lemtrada.

Anyone who believes they are experiencing MS symptoms should see a doctor. Initial symptoms could involve unexplained weakness and sensory changes.

Receiving treatment early on could slow the progression of MS.

Learn more about the progression of MS.

The following are answers to some commonly asked questions.

What does demyelination on the spinal cord mean with MS?

MS causes the immune system to attackTrusted Source the myelin sheath that surrounds nerves in the brain and spinal cord. Over time, inflammation can cause demyelination and scarring. Doctors refer to visible areas of damage on the spinal cord or brain as lesions or MS lesions.

How serious is demyelination on the spinal cord?

Spinal cord lesions are sometimes associated with worse neurological outcomes for a person with MS. They can also cause pain, numbness, and difficulty walking.

Is spinal cord demyelination treatable?

Some areas of demyelination and some lesions noted on imaging tests are treatable. Doctors may prescribe infusions or oral or injectable treatments to slow disease progression.

What does MS spinal cord demyelination feel like?

MS spinal cord demyelination may cause numbness, itching, pain, or tingling.

MS is a complex condition in which the immune system attacks myelin, the protective coating of nerves, causing areas of damage called demyelination.

A person living with MS may have demyelination in parts of the brain, spinal cord, or optic nerve. Limited research suggests that having MS lesions in the spinal cord may indicate worse neurological outcomes of MS.

Symptoms of MS can differ from person to person and day to day. A range of medications can help slow the progression of the disease, but there is no cure for MS yet.

Multiple sclerosis resources

Visit our dedicated hub for more research-backed information and in-depth resources on multiple sclerosis (MS).