Article written by
Nyaka Mwanza

• Brain lesions in multiple sclerosis are caused by an abnormal immune system response.
• Lesions in the central nervous system cause different symptoms, dependending upon their location, size, and severity.
• Disease-modifying medications and lifestyle changes can help prevent multiple sclerosis brain lesions from forming or worsening.

Lesions in multiple sclerosis (MS) are the result of damage to the cells of the central nervous system, which is made up of the brain and spinal cord. “Sclerosis” refers to the characteristic scar tissue that forms in lesions in the brains of people who have MS. MS lesions are also known as scleroses or plaques. This scar tissue is a result of damage to myelin (a fatty tissue that insulates nerve fibers) and the inflammatory processes characteristic of MS.

Lesions in people with MS usually appear in the brain stem, cerebellum, spinal cord, and optic nerves. Lesions can appear in one specific area of the brain, in multiple areas, or in large swathes of the central nervous system.

What Causes Brain Lesions?

Brain lesions can have many different causes. Age, a family history of brain lesions, trauma, and viral or bacterial infections are just a few things that can cause brain lesions. Autoimmune diseases, such as lupus and MS, are another. In the case of MS, brain lesions are the result of inflammation and damage caused by a misfiring immune response and the formation of scar tissue.

How Do Brain Lesions Cause MS Symptoms?

Symptoms of MS vary from person to person and are largely dependent on where MS lesions develop in the central nervous system. The severity, size, and location of lesions all influence what functions of the central nervous system are impacted.

Frontal Lobe

The frontal lobes are the largest of the brain’s lobes. They are located immediately behind the forehead. The frontal lobes comprise the motor area, which is responsible for voluntary movement. The frontal lobes also control memory, intelligence, reasoning, concentration, and aspects of our personality. Lesions on the frontal lobe can cause symptoms including speech impairment, loss of motor function on one or both sides of the body, and changes in mood or behavior.

Parietal Lobe

The parietal lobes are located at the center of the brain. This is where sensory information is processed. Our parietal lobes allow us to feel temperature, taste, touch, and movement. The parietal lobes are also responsible for our ability to read and do math. Lesions in the parietal lobes may cause symptoms such as forgetting words for common objects and loss of sensations such as heat, cold, and pain.

Occipital Lobe

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, our occipital lobes enable us to identify what we’re seeing. Symptoms of lesions in the occipital lobes may present as changes to vision. Optic neuritis, which can include blurry vision and pain with eye movement, is a common early symptom of MS.

Temporal Lobe

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 our senses of hearing, touch, and smell. The temporal lobes also play a role in forming and storing memories. Lesions in the temporal lobes can result in cognitive symptoms, including forgetfulness, moodiness, 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.

Brain lesions do not always cause noticeable symptoms, especially in the case of clinically isolated syndrome (CIS) and early phases of different types of MS. Brain lesions that do not cause symptoms are known as “silent” lesions. If lesions worsen with time, symptoms become more noticeable.

How Do Doctors Detect Brain Lesions?

In some instances, lesions or symptoms of lesions are detected during an exam, scan, or routine monitoring for an unrelated condition. Brain lesions appear as darker or lighter spots on a magnetic resonance imaging (MRI) scan. Other times a person's neurologic symptoms bring them to the doctor’s office.

Sometimes, these symptoms lead to a diagnosis of MS or clinically isolated syndrome. The findings from an MRI scan are vital diagnostic indicators. The type, size, and distribution of brain lesions in MS are also an important part of the McDonald diagnostic criteria. This is the set of criteria most frequently used to diagnose MS and monitor MS disease progression.

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 use vibration or hot or cold objects to assess the ability to detect sensations. The doctor may pinch a person’s cheek or other part of the body to check pain responses. These stimulus response tests may also help pinpoint the possible location of the lesion or lesions.

Diagnostic Imaging Tests for MS Lesions

Computed tomography (CT) is a type of 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.

Magnetic resonance imaging is a noninvasive diagnostic tool that uses magnetic fields and computer technology to produce three-dimensional images of the brain. MRI shows greater detail in brain tissue, the cerebellum, and brain stem than a CT scan. MRI conducted with a contrast fluid called gadolinium can show whether or not the lesions are active (recent) and whether there is evidence of preexisting inflammation or lesions. If lesions do not appear brighter on a high-contrast MRI, they’re likely older than three months.

If you or your health care provider suspect your symptoms may be related to brain lesions, prompt attention is your best bet. A timely, thorough evaluation by a neurologist with specialized training is very important to identify the underlying cause of the lesions and recommend the most appropriate treatment plan.

Preventing New or Worsening MS Lesions

There are more than 15 disease modifying therapies (DMTs) approved by the U.S. Food and Drug Administration (FDA) to treat relapsing MS or progressive MS. Different treatments for MS have varying mechanisms of action. The different mechanisms of DMTs include:

• Reducing inflammation and demyelination (damage to and destruction of myelin)
• Managing the response of immune system cells
• Reducing the quantities of certain immune system cells involved in MS attacks

Other Ways to Keep Your Brain Healthy

Multiple sclerosis 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 things other than MS, such as aging or stroke.

Maintaining a generally healthy lifestyle, including diet and exercise, can also go a long way toward keeping your brain functioning smoothly, whether or not you have MS. There are several things you can do to help keep your brain healthy when you have multiple sclerosis.

Here are some ways to limit your risk for new or worsening brain lesions:

• Stop smoking. Toxins in cigarette smoke can exacerbate brain lesions and their symptoms. Studies have shown people who smoke are more likely to develop MS.
• Control your blood pressure. Vascular disease and issues such as stroke and high blood pressure can cause lesions in the brain.
• Eat a healthy diet. Diets high in excess fats have been linked to lesions in the brain. Maintaining a heart-healthy diet that is low in fat and cholesterol can reduce the likelihood of more lesions.
• Wear a helmet when riding your bike or playing contact sports. Traumatic brain injury can cause or worsen lesions.

When you join MyMSTeam, you gain a support group of more than 150,000 other people who are living with multiple sclerosis. Brain lesions are a frequent topic of conversation among MyMSTeam members.

Here are some recent conversations about brain lesions on MyMSTeam:

• “Everything I’ve read about MS doesn’t say lesion getting smaller means it’s getting better.”
• “I talked to my neuro today about my MRI from a few days ago, and I have a new lesion on my brain.”
• "Could my symptoms be MS-related even if there is no lesion activity?"

Here are some question-and-answer threads about brain lesions on MyMSTeam:

• “Do you know where your lesions are located?”
• “Is there a roadmap for lesions?”

Do you have questions about brain lesions and MS? Comment below or start a new conversation on MyMSTeam.

References

1. Multiple Sclerosis: Hope Through Research — National Institute of Neurological Disorders and Stroke (NINDS) | National Institutes of Health (NIH)
2. Brain Lesions: Symptoms, Causes, Treatments — Cleveland Clinic
3. Lesion — Multiple Sclerosis Trust
4. Imaging in multiple sclerosis — Journal of Neurology, Neurosurgery & Psychiatry
5. Magnetic Resonance Imaging (MRI) — National Multiple Sclerosis Society
6. Brain lesions — Mayo Clinic
7. Brain Basics: Know Your Brain — National Institute of Neurological Disorders and Stroke | National Institutes of Health
8. Computed Tomography (CT) Scan: Preparation & Test Details — Cleveland Clinic
9. Magnetic Resonance Imaging (MRI) — Cleveland Clinic
10. Myelin — National Multiple Sclerosis Foundation
11. Neurological Diagnostic Tests and Procedures Fact Sheet — National Institute of Neurological Disorders and Stroke (NINDS) | National Institutes of Health (NIH)
12. McDonald criteria — Multiple Sclerosis Trust
13. Clinically Isolated Syndrome (CIS) — National Multiple Sclerosis Foundation

Nyaka has worked with large global health nonprofits focused on improving health outcomes for women and children. Learn more about her here.