MS Lesions: How Much Does Location Matter?

So much has changed in the two decades since I was diagnosed with multiple sclerosis (MS). We could all tell stories about the evolution and progression of our own understanding of our disease and its symptoms, as well as that of our medical providers.

From the medical 180-degree turn on pain being recognized as an MS symptom to acknowledgment of the importance of exercise and diet, and now words like “vaccine” and “cure” are making their way into the discussion in a real sense. These past 20-odd years have really seen some massive shifts.

Our Understanding of MS Lesions May Be Evolving

One comment I remember from my early appointments with my neurological team had to do with the placement of lesions on my brain’s white matter relative to clinical symptoms. I remember asking about “silent exacerbations” and how I might have new plaques visible on my MRI scan but no new symptoms.

I also wondered why a new white spot on my MRI sometimes created symptoms in areas of my body that I knew from my basic understanding of neurology had nothing to do with that part of the brain.

The answer, at the time, was that MS is a white matter disease and not a gray matter one. White matter is made up of nerve fibers, which connect nerve cells in different areas of the brain and carry nerve impulses between them, and gray matter is composed of the nerve cells, or neurons.

As it was explained to me, the “wiring” of our brains is all a bit different. Where a nerve fiber comes from and where it leads to can be a tangled web, in the way one old-timey telephone operator’s plugs and wires might be different from those of the next switchboard operator down the line. At least that was the way I understood it.

I remember asking if any of the spots I was looking at on the films were likely to be worse because of where they were. The answer then was “No, we don’t think so.” Well, that may have just changed.

Periventricular Lesions May Be Particularly Problematic

New research published in the journal Brain seems to suggest that lesions located near the brain’s ventricles (called periventricular lesions) may be less likely to remyelinate than others and therefore more likely to cause greater neurodegeneration in the future. (As described in an earlier study, some degree of spontaneous remyelination occurs in people with MS, but it “eventually fails in most patients as they age.”)

The ventricles, according to Mayo Clinic, are large, open, fluid-filled structures that lie deep in the brain.

Hearing about these periventricular lesions is scary but …

Could Brain Health Exercises Help?

As I’ve oft said in the pages of Life With Multiple Sclerosis, forewarned is forearmed. If our medical team sees these periventricular white spots on an MRI, we can now assume they will not repair themselves to any great degree. That being the case, we might want to consider some preemptive brain health exercises.

A strong, healthy body will recover better from injury or illness than an unhealthy one, and the same can go for the mental capacity of our brains. In this case, it’s more like an athlete rehabilitating an injury not just to recover but also to strengthen against further injury: When you see a spot near a ventricle, it’s time to do the mental equivalent of stretches and weight training.

What might those exercises be?

One study found that reading and writing, in particular, were related to higher hippocampal volume — indicating a greater neurological reserve — and better memory.

And one review of studies found that computerized cognitive training can improve some thinking and memory functions in people with MS.

What about brain teasers, sudoku puzzles, and activities like watching and playing Jeopardy? They certainly won’t hurt, but if you’re concerned about how MS is affecting your cognitive function, it’s worth talking to your neurologist about evidence-based cognitive training programs that might be available to you.

A Bad News, Good News Type of Study

The bad news from the study, of course, is “that not only remyelination is selectively poor in periventricular regions, but also periventricular lesions play a significant role in driving neurodegeneration in people with MS.”

The good news is that this new information helps us to understand more about how the disease works. And while the Brain study doesn’t examine how this damage might be prevented, we know from other research that there may be things we can do to maintain and improve our cognitive function.

Remember, most of what we have control over in our lives with MS is how we react and respond. Here is information that gives us something upon which to react in a way that could benefit our long-term brain health.

Wishing you and your family the best of health.



My book Chef Interrupted is available on Amazon. Follow me on the Life With MS Facebook page and on Twitter, and read more on Life With Multiple Sclerosis.

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