The spinal cord will take center stage in Scientific Session 18 at ECTRIMS 2025.
What is spinal cord reserve, and how can we monitor disease progression using spinal cord imaging? Prof Jiwon Oh and Dr Jaume Sastre-Garriga will guide the audience through the latest research and clinical insights.
Demyelinating spinal cord disease is common in people with multiple sclerosis (MS) but it often receives less attention than brain involvement [1]. This may be because there has been some uncertainty about the clinical and therapeutic relevance of spinal cord assessment [1]. The MS clinic-radiologic paradox – a substantial disconnect between radiological and clinical observations – is encountered especially in the spinal cord [2].
The North American Imaging in Multiple Sclerosis Spinal Cord Interest Group was established to assess the state of the art in spinal cord evaluation in MS and to foster collaborative research initiatives [1]. Serious damage to specific areas of the spinal cord may play a key role in worsening motor symptoms in people with multiple sclerosis (MS). Research suggests that when damage in the spinal cord reaches a certain level, it can be associated with disability [1].
Spinal cord reserve may help buffer the effects of damage in multiple sclerosis (MS). Dr Sastre Garriga and colleagues found that a larger area of the spinal canal – used as an estimate of the spinal cord’s maximum lifetime growth – was linked to lower scores on the Patient Determined Disease Steps (PDDS), a patient-reported outcome measure. This suggests that larger spinal cord reserve may offer some protection against disability in MS [4].
Dr. Jaume Sastre-Garriga from Cemcat says:
“Central nervous system (CNS) reserve can be defined as the “capital” that each person accumulates over a lifetime, particularly before the disease.”
Over a lifetime, people build up a brain and spinal cord reserve that help reduce the effects of neural decline [4]. People with a higher reserve can cope with a larger damage before experiencing symptoms [5]. Although aging and disease burden can wear down this reserve, it can also be preserved through a healthy lifestyle and effective treatments [6].
References:
[1] Keegan BM et al Brain Comm. 2024; 6(6): fcae395.
[2] Oh, J et al Neurology 2013; 80(6): 540-547.
[3] Sastre-Garriga J JNNP 2023; 94(7), 502-510.
[4] Fittipaldi S et al Nat. Mental Health 2024; 1-13.
[5] Stern Y Neuropsychologia 2009; 47(10), 2015-2028.
[6] Brandstadter R, Katz Sand I & Sumowski JF (2019). Mult. Scler. J. 2019; 25(10), 1372-1378.