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In multiple sclerosis (MS), lesions (areas of damage) develop when the immune system mistakenly attacks the central nervous system (CNS), which includes the brain, optic nerves, and spinal cord. The term “sclerosis” refers to the scar tissue that forms in these lesions, also called plaques or scleroses. This scarring is a hallmark of MS and results from damage to the myelin sheath — a protective, fatty layer that insulates nerve fibers — along with inflammation that’s part of the disease process.
In people living with MS, lesions most often form in the brain, spinal cord, and the nerves connected to the eyes. Lesions may appear in just one area, in several spots, or across large parts of the CNS.
Brain lesions can develop for many reasons, including:
Autoimmune diseases, such as lupus and MS, can also cause brain lesions.
In MS, lesions in the brain form due to inflammation and damage triggered by an overactive immune system that mistakenly attacks the myelin sheath. This process also leads to the development of scar tissue.
Recent research confirms that MS-related brain lesions occur when the immune system targets the myelin sheath — and sometimes the nerve fibers underneath — leading to chronic inflammation. This immune activity can also weaken the blood-brain barrier, which normally protects the brain by controlling what substances can pass through. Over time, ongoing inflammation may cause permanent scarring.
Symptoms of MS vary from person to person and depend on where MS lesions develop in the CNS. The severity, size, and location of lesions all depend on disease activity and determine which functions of the CNS are affected.
Brain lesions don’t always cause noticeable symptoms, especially in the case of early phases of different types of MS. If these so-called silent lesions get worse over time, symptoms become more noticeable.
The frontal lobes, the largest of the brain’s lobes, are located immediately behind the forehead. The frontal lobes contain the motor area, which is responsible for voluntary movement. They also control memory, intelligence, reasoning, concentration, and aspects of your personality.
Lesions on the frontal lobe can cause symptoms including:
The parietal lobes are at the center of the brain and process sensory information. Your parietal lobes allow you to sense temperature, taste, touch, and movement. They also play a role in skills like reading and solving math problems.
Lesions in the parietal lobes may cause symptoms such as difficulty finding the right words for everyday objects and loss of sensation, including heat, cold, and pain.
The occipital lobes are located at the back of the brain. Their job is to process images from the eyes and link that information with images stored in memory. Essentially, your occipital lobes enable you to identify what you’re seeing.
Lesions in the occipital lobes may cause changes in your vision.
The temporal lobes are located in the center of the brain — specifically, they’re in front of the occipital lobes and beneath the parietal and frontal lobes. Temporal lobes play a large role in integrating the senses of hearing, touch, and smell, and they’re key to forming and storing memories.
Lesions in the temporal lobes can result in cognitive symptoms, including moodiness, forgetfulness, and difficulty focusing. Sensory symptoms, such as loss of taste, smell, and hearing, can be symptomatic of lesions in this part of the brain, as can changes in behavior, mood, and emotions.
The first step in diagnosing lesions in the brain may involve a neurologist taking a complete medical history, conducting a physical examination, and performing a detailed neurological exam. The doctor may:
These stimulus-response tests may also help pinpoint the location of the lesion or lesions.
CT is a type of neuroimaging (brain and spinal cord imaging) technology that uses radiation to take images of brain tissue. A solution may be injected into a person’s vein to help highlight brain structures. CT scans can be used to diagnose brain lesions.
MRI is a noninvasive diagnostic tool that uses magnetic fields and computer technology to produce 3D images of the brain. An MRI scan shows greater detail in brain tissue, the cerebellum, and the brainstem than a CT scan. Brain lesions appear as darker or lighter spots on an MRI scan, and the findings are important for making a diagnosis.
MRI conducted with a contrast fluid called gadolinium can show whether the lesions are active (recent) and if there’s evidence of preexisting inflammation or lesions. If lesions don’t appear brighter on a high-contrast MRI, they are likely not new lesions and are older than three months.
The type, size, and distribution of brain lesions in MS are also an important part of the McDonald criteria — the set of diagnostic criteria developed by an international panel of health experts that’s most frequently used to diagnose MS.
The U.S. Food and Drug Administration (FDA) has approved more than two dozen disease-modifying therapies (DMTs) to treat relapsing or progressive MS. Different treatments for MS work in different ways, which include:
Highly effective (HE) DMTs are especially good at slowing disease and disability progression in some people. HE DMTs include:
Recent research encourages early initiation of these high-efficacy therapies rather than the traditional “step-up” approach, which helps prevent long-term brain damage and new lesion formation.
Over time, you may switch treatments for MS for various reasons, including:
MS is a chronic illness with no known cure. Regular monitoring and follow-up care are important parts of tracking and managing disease progression. Brain lesions can be caused or worsened by factors other than MS, such as aging or stroke.
Maintaining a generally healthy lifestyle, including eating nutritious foods and being physically active, can go a long way toward keeping your brain functioning smoothly, whether or not you have MS.
Toxins in cigarette smoke can make MS brain lesions and their symptoms worse. Research shows that people who smoke are more likely to develop MS and may experience faster disease progression.
In a 2022 study of 85 people living with MS, those who smoked had more brain lesions (higher lesion volume), greater brain atrophy (shrinkage), and more disability after 10 years compared to those who didn’t smoke. Researchers noted that more studies are needed to fully understand the link between smoking and MS lesions.
If you use tobacco and want help quitting, talk with your healthcare provider.
If you’re living with MS, making healthy choices can help protect your brain and reduce your risk of developing new lesions — especially those caused by factors outside of MS. Try these strategies:
On MyMSTeam, people share their experiences with multiple sclerosis, get advice, and find support from others who understand.
What changes or habits have helped you feel more in control of your MS and protect your brain health? Let others know in the comments below.
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I Notice When I Was Going Through My Mri With Contrast I Can Feel The Contrast So It Can Illuminate I’m Making Note
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I have had MS for about 40 years. This article is very informative. It would be excellent for someone just being diagnosed with MS. It is well written.
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