What is Spinal MS?

Maybe you have heard the term “Spinal MS.” What is that? I thought MS could be relapsing, primary progressive, secondary progressive, or “benign.”

The lesions caused by multiple sclerosis can occur anywhere within the central nervous system, which includes the brain, the spinal cord, and the optic nerves. Approximately 55-75 percent of patients with MS will have spinal cord lesions at some time during the course of their disease. If a patient does have lesions in the spinal cord, he/she may be said to have Spinal MS.

A smaller number of MS patients, approximately 20 percent, may have only spinal lesions and not brain lesions. I am an example of one of those 20 percent of MS patients who only have spinal lesions.

Symptoms of Spinal MS

Spinal MS occurs more commonly with lesions in the cervical spine (the neck area) in approximately 67 percent of cases. Lesions in this area often affect the corticospinal tract. Neurological signs which indicate lesions in the corticospinal tract include the Babinski Sign and the Hoffmann Sign. Additional indicators of lesions in the upper spine include the l’Hermittes phenomenon and the Romberg Sign. At one time or another, I have shown each of these signs of neurological involvement/interference due to MS lesions.

Although the location of lesions do not always closely correlate to areas of clinical disability, there are cause/effect patterns which do emerge. Patients with spinal cord lesions are more likely to develop bladder dysfunction (e.g., urinary urgency or hesitancy, partial retention of urine, mild urinary incontinence), bowel dysfunction (e.g., constipation or urgency), and sexual dysfunction (e.g., erectile dysfunction or impotence in men, genital anesthesia or numbness in women, pain with intercourse for either sex). Complete loss of bladder and bowel control may be lost in more advanced cases of MS.


Spinal cord lesions can also lead to sensory and motor deficits, including dysesthesias, spasticity, limb weakness, ataxia or other gait disturbances.

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What is Spinal MS?

Is CIS the same as MS?

When someone experiences a single demyelinating or inflammatory attack of the central nervous system that causes neurological symptoms resembling MS, it is called clinically isolated syndrome, or CIS. Here are some common questions about CIS and how it is distinguished from other forms of MS.

Is CIS the same as MS?

According to updated recommendations redefining the phenotypes of MS made in 2014, CIS is considered an official form of MS. However, not everybody who experiences an episode of CIS will go on to develop full-blown multiple sclerosis.

How does CIS resemble other forms of MS?

An episode of CIS includes neurological symptoms that last for 24 hours or longer and are caused by inflammation or demyelination within the central nervous system (CNS). Myelin is the fatty substance that surrounds and protects nerves. Myelin helps to speed messages along nerves, and a loss of myelin serves to slow down the messages or keep them from getting through in the first place. A place where inflammation has attacked the myelin is called a lesion. The effects of demyelination are the same for each form of MS.

An attack of CIS can be monofocal — involving a single symptom related to a single lesion — or multifocal — involving more than one symptom caused by lesions in different locations in the CNS. The CNS includes the brain, spinal cord, and optic nerves. An episode of CIS is often followed by complete or partial recovery.

How is CIS diagnosed?

Similar to other diseases of the central nervous system, diagnosis of CIS may include laboratory tests to eliminate other potential causes of symptoms, a complete neurological exam to access function of the nerves, a thorough medical history, and magnetic resonance imaging (MRI) to look for evidence of inflammation or demyelination within the CNS. Depending upon symptoms, the recommended MRI given at this stage of diagnosis may only include the brain and not the spinal cord.

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What Is Clinically Isolated Syndrome?

What is Aggressive Onset MS?

Multiple sclerosis is a disease which affects people in many different ways. For some, it can be relatively mild, while for others it can be very aggressive and cause high levels of disability in a short period of time. The more aggressive presentation of MS has been called “malignant MS” or “highly active MS” or simply “aggressive MS.” This type of MS would be different from advanced MS, in that disability accumulates very quickly, up to Expanded Disability Status Scale (EDSS) score 6.0, within the first few years after diagnosis. Patients with aggressive onset MS, or AOMS, may have smaller windows of opportunity for receiving the most effective treatment to slow down the disease.

Studying aggressive onset MS (AOMS)

To date, there are no established criteria or biomarkers by which neurologists can easily identify cases of aggressive MS. To learn more about this type of MS, researchers in New York reviewed the published literature to carefully select a set of criteria with early clinical features and MRI findings that doctors can use to identify these cases. They published their findings in August 2016 in the Journal of Neuropsychiatric Disease and Treatment. The criteria included: 1) two or more relapses in the year after disease onset and two or more gadolinium-enhancing lesions on brain MRI scans; or 2) one relapse if it results in sustained disability (at least EDSS 3.0) along with two or more gadolinium-enhancing lesions.

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Aggressive MS Needs Early Aggressive Treatment

What is Benign MS?

Multiple sclerosis is a disease of the central nervous system. There are traditionally four forms of the disease that include relapsing-remitting MS (RRMS), secondary progressive MS (SPMS), primary progressive MS (PPMS), and progressive relapsing MS (PRMS). A 2014 update to the description of the subtypes of MS added clinically isolated syndrome (CIS) to the list and removed PRMS. An unofficial subtype of multiple sclerosis is benign MS.

What is benign MS?

Although there is no universally agreed upon definition of benign MS (BMS), the term is typically used to describe a disease course where patients experience little disease progression and minimal accumulation of disability decades after developing the disease. Benign MS is a retrospective diagnosis that can only be made 10 years or more after disease onset.

Your neurologist may look back on how MS has affected you and determine that your version of MS has been “benign” or fairly mild. Disability in MS is measured by the Expanded Disability Status Scale (EDSS) that is scored from 0 (no disability) to 10 (death). An EDSS 2.0 score represents mild disability in one functional system, such as decreased sensation in all four limbs, and EDSS 3.0 represents mild disability in several functional systems or moderate disability in one system while the patient is still able to walk unassisted.

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What is Benign MS and How Is It Treated?

Redefining MS: New Names for MS Subtypes

During the past 18 years, much has been learned regarding the pathology of MS including early manifestations of the disease which precede confirmed diagnosis.  This increased understanding of MS and limitations in the current terminology used to describe MS prompted a re-examination of the disease subtypes by the International Advisory Committee on Clinical Trials of MS which convened in October 2012.  Consensus and recommendations offered by the advisory committee were published online in the journal Neurology on World MS Day, May 28, 2014.

The committee recommends that the core descriptions of relapsing and progressive disease should be maintained, with certain modifications and clarifications.  Suggested modifications include assessment of disease activity, as defined by clinical relapses and/or MRI activity (contrast-enhancing lesions; new or unequivocally enlarging T2 lesions assessed at least annually), and clinical evidence of disease progression independent of relapses over a given period of time in patients who have a progressive disease course (PPMS or SPMS).

The following are examples of newly proposed descriptions that consider measures of disease activity.  A patient with RRMS who has a new gadolinium-enhancing lesion would be considered to be “RR–active.”  Conversely, a patient with a relapsing course but no relapses, gadolinium-enhancing activity, or new or enlarging T2 lesions would be “RR-not active.”  A patient with PPMS with no acute attacks and no MRI activity would be “PP–not active.”  However, a patient with PPMS who has an acute attack would be “PP–active,” replacing the current progressive-relapsing MS definition.

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Redefining MS