A team at the National Institutes of Health has found that certain brain lesions (areas of MS activity or damage identified using MRI) are linked with a more severe course of MS. These results may help direct the development of new treatments aimed at these brain lesions to stop MS progression. The team is led by Daniel Reich, MD, PhD, and includes Martina Absinta, MD, PhD, who is funded by a postdoctoral fellowship from the National MS Society and the Conrad N. Hilton Foundation.

These researchers used a powerful 7-Tesla MRI scanner (which allows researchers to see with greater detail much smaller areas of the brain than a conventional MRI scanner) to track the evolution of MS brain lesions over time. They previously reported that lesions that have undergone natural repair lose their distinct edge, or rim, that surrounds them. Some lesions have persistent rims of “smoldering” inflammation, which appear to indicate tissue damage that was not repaired.

In this study, the team looked at lesions that did or did not have such rims in 192 people with MS. Individuals who had four or more lesions with rims were more likely to develop progressive MS, and to experience earlier mobility and cognitive impairments and more brain tissue volume loss. The rims appeared in some people regardless of whether or not they received treatment with disease-modifying therapies. This reinforces the need to develop new treatments that can address smoldering inflammation inside the brain to stop MS progression.

The team has shared a program that will enable other researchers to detect smoldering lesions with less powerful MRI scanners that are more commonly used in clinics to encourage their incorporation in research and future clinical trials. They also are continuing to study such MRI signal changes in people with MS.