Spinal Cord Atrophy and Paramagnetic Rim Lesions in Multiple Sclerosis Progression

Inflammatory activity in multiple sclerosis (MS) is associated with relapses and new lesion formation, whereas progression is associated with chronic inflammation and neurodegeneration. Progression seems to begin early in MS, challenging the notion that it is a late phase of the disease (NEJM JW Neurol 2023 Dec 11 and JAMA Neurol 2023 Nov 27; [e-pub]). To evaluate the MRI substrate of progression independent of relapse activity (PIRA), investigators used the Swiss MS Cohort, which included an observational collection of clinical and MRI data from multiple centers.

More than 1500 MRI scans from 445 patients were included. During a 4-year period, 74 patients experienced PIRA. A smaller spinal cord cross-sectional area was found in MS patients …