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Critical demyelinating lesions in progressive multiple sclerosis: a prospective observational study.
Rowaid Ahmad1,2, Caitlin S Jackson-Tarlton1,3, Eoin P Flanagan1,4
1Department of Neurology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA.
Journal of Neurology
|October 6, 2025
Summary
Critical demyelinating lesions are frequently observed in individuals with progressive multiple sclerosis (MS), particularly within the spinal cord. These lesions are associated with motor impairment, highlighting their importance in MS progression.
Area of Science:
- Neurology
- Neuroimmunology
- Radiology
Background:
- Critical demyelinating lesions are linked to progressive motor deficits in multiple sclerosis (MS).
- Previous studies focused on highly selected MS cohorts.
- The frequency in unselected progressive MS populations remains unclear.
Purpose of the Study:
- To determine the prevalence of critical demyelinating lesions in an unselected cohort of patients with progressive MS.
- To investigate the association between critical lesions and motor impairment in progressive MS.
- To analyze the location and characteristics of critical lesions in progressive MS.
Main Methods:
- Prospective observational cohort study of 255 individuals with progressive MS.
- Evaluation of brain and spinal cord MRIs for demyelinating lesions involving corticospinal tracts.
- Classification of lesions as single critical, tandem critical, or high lesion burden.
- Clinical data extracted via chart review, assessing motor and non-motor impairment.
Main Results:
- Critical demyelinating lesions were identified in 26.3% of participants.
- The majority of critical lesions were located in the spinal cord (90.7%).
- Individuals with critical lesions were older and more likely to present with hemiparesis.
Conclusions:
- Critical demyelinating lesions are common in people with progressive MS.
- These lesions are frequently located in the spinal cord.
- Their presence is associated with progressive motor impairment, underscoring their clinical significance.
