Just sharing : Knowledge and understanding of MS seems to be developing rapidly and we now have ‘smouldering lesions’, ‘paramagnetic rim lesions’ (i think that the correct term), and ‘slowly expanding lesions’.
As I understand things , current DMTs are good at limiting the number of relapses, but none of them really tackle the underlying progression that occurs in all MS ( including RRMS). These new understandings about slowly expanding and smouldering might (should ?) lead to treatments that get to the heart of MS
I’m still trying to get my head around it as I’ve got a lesion that has been active and getting bigger for a while now. Is that a smouldering lesion? Some of mine however have got smaller too.
If you search for Professor Giovanonni he has a lot to say about smouldering lesions and the notion that MS is MS . Sign up for his updates,podcasts and the like.
I struggle to understand it all but my vague general lay person’s understanding is roughly that:
MS is active way before we develop any noticeable symptoms.
We probably all have lesions before we develop symptoms and similarly not all lesions result in noticeable symptoms. This is possibly partly a result of fact that particularly when we are younger the brain will easily find new pathways for signals and some lesions will be in areas of the brain and spinal cord where the impact isn’t that noticeable in day to day life
Again, particularly when we are younger , the brain can repair itself, lesions ( but not all) will shrink and inflammation die down
The distinction between PPMS, RRMS and SPMS is a bit artificial and mainly to do with drug licensing regulations. My way of thinking is that we all have continuing/ progressive MS with a mix of new lesions and the growth of existing ( getting larger ) lesions.
Lesions form when the immune system attacks some part of the brain or spinal cord, causing inflammation which will die down but like any flesh wound, after the initial redness and inflammation, it leaves a sort of ‘scab’ - a lesion which shows up on MRI scans.
So, yes to my limited understanding, lesions can shrink although the damage done to functioning of the nerves remains. Other lesions smoulder away and can expand.
I would find it really useful if the MS Society and\or the MS Trust could organise a short e.g Future Learn course on MS
Blimey ! That’s a massive task . At one level they are all treatments that in trials showed that they reduced the number of MS relapses and formation of new lesions. . What they don’t do however is stop the long term slow progression of disability that results from old attacks/ lesions . I’ve had no new lesions for 17 or more years but the damage caused by old attacks/lesions is getting worse. They might delay the start but don’t stop it ( others might correct me on this). From my admittedly limited understanding they work in different ways and the more recent ones are significantly more effective than the older ones. The more recent ones, however, also bring some potentially more serious risks than the older ones. I’m on an older one .
Others on the Forum might well have better and more accurate information.
