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What lesions & brain matter changes mean for MS

Multiple sclerosis (MS) lesions can occur throughout the central nervous system (CNS) and can lead to MS symptoms and relapses.
MS can also impact the volume of brain matter, which is important to understand if you’re living with the disease.

Lesions in
the central nervous system

MS lesions can occur in all three parts of the CNS—the brain, spinal cord, and optic nerves. These lesions interfere with the brain’s ability to communicate with the rest of the body and have an impact both physically and cognitively.

central nervous system + Lesions

Lesions in the central nervous system scheme

There are two types of brain
matter—and lesions can occur in both

Lesions on grey and white matter scheme

The brain is made up of two types of tissue: grey matter, which is where communication signals start, and white matter, which carries messages from one area to another.

MS lesions can occur in both grey and white matter and lead to the symptoms you experience. For many years, researchers focused primarily on white matter when it came to MS. And while white matter is important (about 95% of all MS lesions develop there), recent research has revealed that lesions and a decrease in grey matter (also known as brain volume loss) may have a much greater impact on MS than once believed.


Lesions can change over time

Lesions often progress over time. That’s why identifying them early and monitoring them regularly are important. This progress is monitored by using magnetic resonance imaging (MRI) scans. These scans produce three kinds of images.

GdE LESIONS

GdE lesions on MRI example

GdE LESIONS

Lesions begin as inflammation.

These are called GdE (gadolinium⁠-⁠enhancing) lesions.
In the GdE MRI, a liquid dye is injected into the body to make areas of inflammation visible.

T2 LESIONS

T2 lesions on MRI example

T2 LESIONS

If inflammation persists, it can lead to new lesions or cause existing lesions to evolve.

These are called T2 lesions. They show up as “bright white spots” on an MRI.

T1 LESIONS

T1 lesions on MRI example

T1 LESIONS

Over time, lesions can mature—becoming permanent scars in the brain.

These are T1 lesions. They appear as dark areas or “black holes” on an MRI.


Brain matter decreases in ms

Decreases in brain matter
and why it matters

As we age, we all lose brain matter (both white and grey) naturally. For people with MS, this decrease in brain matter (also called brain volume loss) may happen more quickly.

Both white matter and grey matter can be damaged by MS, resulting in brain volume loss. Research now shows that the decrease in the volume of grey matter may help predict long-term physical disability and cognitive changes. Cognitive changes caused by MS may include worsening of memory, difficulty concentrating, or trouble thinking of the right word. Be sure to talk to your MS healthcare team to learn more.