It is therefore important to diagnose MS as early as possible, before Neurological Reserve is exhausted and the progressive stage of the disease begins.
—Giovannoni et al2
In Multiple Sclerosis (MS), permanent damage to White Matter and Grey Matter (GM) begins early in the course of disease—driven by both inflammatory and neurodegenerative mechanisms.2-5 Both WM and GM pathologies are important drivers of disease activity in patients with MS.
This central nervous system (CNS) damage includes not only relapses, White Matter lesions, and a decline in physical function, but also whole brain volume loss, Grey Matter atrophy (including thalamic atrophy), cortical lesions, and cognitive impairment.1-8
Evidence shows that early damage can impact Neurological Reserve–the finite capacity of the brain to retain function by remodeling itself after an MS-related injury.2
While the brain is naturally able to compensate for tissue damage for a period of time, some nerve tissue is irreversibly destroyed, causing permanent injury and a loss of brain volume.2
Ironically, the brain’s ability to compensate for early nerve damage may actually mask the ongoing neurodegeneration taking place, causing it to go unrecognized until Neurological Reserve has significantly deteriorated.2
View references on Neurological Reserve.
Historically, early multiple sclerosis damage has been associated with White Matter,11,12 with an emphasis on focal demyelinating lesions in White Matter tissue.10,13 However, while early damage to White Matter is an important contributor to disease activity, it is just 1 component of a comprehensive approach to understanding multiple sclerosis and neurological function.
White Matter pathology alone does not fully explain disease activity in multiple sclerosis, as it is only moderately correlated with outcomes (such as disability).14,15 Grey Matter pathology in the central nervous system (brain and spinal cord) has been identified to play an important role.10,16,17
View references on White Matter pathology.
…THE MOST VISIBLE ELEMENT OF PATHOLOGY, WHITE MATTER (WM) LESIONS, REPRESENTS ONLY A FRACTION OF THE DISEASE BURDEN BORNE BY THE BRAIN…CHARD ET AL18
View references on Grey Matter atrophy.
In a prospective longitudinal MRI study of 107 MS patients,