Mayo Clinic researchers have identified clear differences in brain and spinal cord scarring in patients with demyelinating diseases.

Study can improve understanding of how disability develops in MS

Mayo Clinic researchers have identified clear differences in brain and spinal cord scarring in patients with demyelinating diseases. The findings can potentially shed light on how progressive disability develops in multiple sclerosis (MS) and ultimately indicate treatment pathways.

The study, published in Neurology (Comparison of MRI Lesion Evolution in Different Central Nervous System Demyelinating Disorders), analyzed whether inflammation leads to permanent scarring in three demyelinating diseases:

• MS
• Myelin oligodendrocyte glycoprotein IgG-associated disorder (MOGAD)
• Aquaporin-4 antibody positive neuromyelitis optica spectrum disorder (AQP4-NMOSD)

Study participants were Mayo Clinic patients diagnosed with one of the three diseases. The results of MRI performed on the patients at the time of acute attacks and six months later were compared.

The researchers found that areas of scarring or lesions in MS reduced less over time compared with MOGAD or AQP4-NMOSD lesions. Individuals with MOGAD and AQP4-NMOSD generally don't experience the slowly progressing disability that's typical of MS.

MOGAD and AQP4-NMOSD attacks usually involve large areas of inflammation. But the Mayo Clinic researchers found that MOGAD lesions tended to disappear completely over time — which fits well with the overall good long-term prognosis for these patients.

AQP4-NMOSD attacks often result in severe symptoms and permanent problems. However, the scars visible on MRI tend to be smaller than in MS — a possible clue to why individuals with AQP4-NMOSD generally don't develop a secondary progressive course.

"We hope that the improved understanding of the ways MOGAD repairs its lesions so well may lead to novel treatment avenues to prevent scar formation in MS," Dr. Flanagan says.

Read the full news release here.