Cortical injury in multiple sclerosis; the role of the immune system

Area of Science:

• Neuroimmunology
• Neuropathology
• Neuroimaging

Background:

• Multiple sclerosis (MS) has traditionally been viewed as a white matter disease due to prominent demyelination and neuronal damage.
• Recent advancements in MRI and neuropathology reveal significant disease activity within the cerebral cortex (gray matter) in MS patients.
• Cortical pathology in MS is increasingly recognized as a major contributor to disease progression and disability.

Purpose of the Study:

• To review the current understanding of inflammation associated with cortical tissue injury in multiple sclerosis.
• To explore historical and contemporary findings on the presence and absence of inflammation in the cerebral cortex and meninges in MS.
• To highlight the role of meningeal inflammation in cortical damage in MS.

Main Methods:

• Review of historical literature on MS neuropathology.
• Analysis of contemporary research focusing on cortical and meningeal pathology in MS.
• Integration of findings from advanced neuroimaging techniques (e.g., MRI) and neuropathological studies.

Main Results:

• Cortical damage in MS is associated with inflammation, though often less pronounced than in white matter.
• Emerging evidence indicates robust inflammation in both the cerebral parenchyma and neighboring meninges in cases of cortical damage.
• The interplay between cortical pathology and meningeal inflammation is a critical area of ongoing investigation.

Conclusions:

• The cerebral cortex is a significant site of pathology in multiple sclerosis, challenging the historical white matter-centric view.
• Inflammation, particularly involving the meninges, plays a crucial role in cortical damage in MS.
• Further research into cortical and meningeal inflammation is essential for a comprehensive understanding of MS pathogenesis and for developing targeted therapies.