What Is Spinal MS?
You may or may not have MS. You hear terms like lesions, demyelination, oligoclonal bands, brain atrophy, white spots, disease-modifying drugs, etc.
Maybe you have heard the term "Spinal MS." What is that?! I thought MS was either relapsing-remitting, primary progressive, secondary progressive, progressive relapsing, or "benign."
The lesions caused by multiple sclerosis can occur anywhere within the central nervous system which includes the brain, the spinal cord, and the optic nerves. Approximately 55-75 percent of patients with MS will have spinal cord lesions at some time during the course of their disease. If a patient does have lesions in the spinal cord, he/she may be said to have Spinal MS. A smaller number of MS patients, approximately 20%, may have only spinal lesions and not brain lesions. (see emedicine.medscape.com) I am an example of one of those 20% of MS patients who only have spinal lesions.
Spinal MS occurs more commonly with lesions in the cervical spine (the neck area) in approximately 67% of cases. Lesions in this area often affect the corticospinal tract. Neurological signs which indicate lesions in the corticospinal tract include the Babinski Sign and the Hoffmann Sign. Additional indicators of lesions in the upper spine include the l’Hermittes phenomenon and the Romberg Sign. At one time or another, I have shown each of these signs of neurological involvement/interference due to MS lesions.
Although the location of lesions do not always closely correlate to areas of clinical disability, there are cause/effect patterns which do emerge. Patients with spinal cord lesions are more likely to develop bladder dysfunction (eg. urinary urgency or hesitancy, partial retention of urine, mild urinary incontinence), bowel dysfunction (eg. constipation or urgency), and sexual dysfunction (eg. erectile dysfunction or impotence in men, genital anesthesia or numbness in women, pain with intercourse for either sex). Complete loss of bladder and bowel control may be lost in more advanced cases of MS.
Spinal cord lesions can also lead to sensory and motor deficits, including dysesthesias, spasticity, limb weakness, ataxia or other gait disturbances. Explained in a case report summary from University of Rochester Medical Center, most acute symptoms in MS are caused by spinal lesions rather than brain lesions. Dr. Gross explains that it is “not uncommon to discover multiple silent brain lesions” on MRI scans in a patient who is affected primarily with problems related to the spinal cord. These “symptomatic spinal cord lesions are [often] more difficult to identify on [MRI] scans than some clinically quiet” brain lesions.
An acute attack of myelitis is caused by inflammation in the spinal cord. Some patients may be diagnosed with Transverse Myelitis if they are experiencing their first attack of demyelination and inflammation. One of my earlier diagnoses (on the road to getting a firm diagnosis of MS) was acute transverse myelitis. It was treated with five days of IV Solumedrol (steroid) infusions. Significant improvement occurred very quickly.
Similarly, patients who are later diagnosed with Neuromyelitis Optica (NMO) or Devic’s Disease may initially receive a diagnosis of transverse myelitis. NMO is a demyelinating disease of the central nervous system which primarily affects the optic nerves and spinal cord.
In conclusion, if you read the phrase “spinal MS,” know that it simply refers to the presence of lesions in the spinal cord in a patient diagnosed with MS. These lesions may cause various types of sensory and motor dysfunction below the level of the spinal cord involvement. The prognosis of spinal MS does not appear to be more dire than that of MS only affecting the brain. However, the higher incidence of spinal cord lesions often found in primarily progressive MS (PPMS) does contribute to a more rapid development of disability.