Maybe you have heard the term “Spinal MS.” What is that? I thought MS could be relapsing, primary progressive, secondary progressive, 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 percent, may have only spinal lesions and not brain lesions. I am an example of one of those 20 percent of MS patients who only have spinal lesions.
Symptoms of Spinal MS
Spinal MS occurs more commonly with lesions in the cervical spine (the neck area) in approximately 67 percent 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 (e.g., urinary urgency or hesitancy, partial retention of urine, mild urinary incontinence), bowel dysfunction (e.g., constipation or urgency), and sexual dysfunction (e.g., 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.
Conditions similar to Spinal MS
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 Spectrum Disorder (NMOSD) 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.
Spinal MS and disease progression
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 primary progressive multiple sclerosis (PPMS) does contribute to a more rapid development of disability.