Multiple Sclerosis – a leaking swimming pool | Video

This could be an entirely new way to think about Multiple Sclerosis


Dr Stephen Krieger, a neurologist at the Corinne Goldsmith Dickinson Center for Multiple Sclerosis at Mount Sinai Hospital in New York presents a new visualization of multiple sclerosis (MS) disease course “The Topographical Model of MS”.  This shows that the different categories in MS (relapsing-remitting, secondary progressive, and primary progressive) are actually only one disease.

“The main observation of this model is that progress in MS, when it occurs, seems to take the form of prior relapses. For example, take a patient who had a bad relapse of right leg weakness that recovered and got back to normal—if she begins to progress some years later, that progression begins again with the same right-leg weakness that she experienced as part of her relapse. That recapitulation of relapse symptoms permanently in the context of progression, I think, is an important feature in the MS clinical course, and that is what is shown in this model.

The model is principally a visual one and depicts the central nervous system as a pool with a shallow end and a deep end. The shallow end and the deep end refer to different amounts of neurologic and functional reserve—the spinal cord and optic nerves have little reserve, and most relapses in MS happen in these areas. The brain stem has a bit more reserve and is in the middle—certainly some relapses can occur there. Finally, the hemispheres have the most reserve, so most of our periventricular lesions that we think of as being so typical in MS rarely cross the clinical threshold to cause symptoms. That clinical threshold, I think, is really an important feature of the MS clinical course. It’s what defines whether a patient develops signs and symptoms or whether their lesions remain subclinical. So I show, through a series of 3D-rendered models, how the disease course unfold over time.”