Silent Spinal lesions may evetually take their toll

Zecca C, Disanto G, Sormani MP, Riccitelli GC, Cianfoni A, Delgrande F, Pravatà E, Gobbi C.Relevance of asymptomatic spinal MRI lesions in patients with multiple sclerosis.Mult Scler. 2015 Oct 12. pii: 1352458515599246. [Epub ahead of print]

BACKGROUND:The impact of new asymptomatic spinal cord lesions (a-SL) in multiple sclerosis (MS) course is poorly characterized.
OBJECTIVE:The objective of this research paper is to assess the prognostic value of a-SL in predicting MS course.
METHODS:Relapsing-remitting MS patients who received serial MRI (brain and spinal) at baseline (t1) and within 12 to 36 months (t2) during clinical stability, and had a follow-up (t2-t3) ⩾24 months were included. Relapses and disability progression were evaluated between t2 and t3.
RESULTS:Of 413 consecutive screened MS patients, 103 patients (65 females, median age 43 years) were included. After a median t1-t2 interval of 17 (IQR 13-26) months, 25.2% and 43.7% patients had ⩾1 new a-SL (a-SL+) and asymptomatic brain lesions (a-BL+), respectively. Relapse risk between t2 and t3 (median interval: 42 (IQR 32-57.5) months) was significantly increased in a-SL+ and/or a-BL+ vs a-BL- and a-SL- (HR = 2.31, 95% CI = 1.13-4.72, p = 0.02). No differences in the risk of disability progression were found in a-SL+ and/or a-BL+ vs a-SL- and a-BL-.
CONCLUSION: a-SL occur in one-quarter of clinically stable RRMS, and combined with a-BL contribute significantly in predicting future disease course.

As many as 85% of brain lesions are silent and likewise silent spinal cord lesions develop but with time these create more and more damage in nerve tracts and are best not to have them.