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Clinically stable patients with Multiple Sclerosis show 13.0% to 19.1% incidence of new spinal cord lesionsBrain scans may miss hidden spinal cord activity in MS

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Key Takeaway
Recognize that spinal cord activity may be missed when surveillance relies on brain MRI alone in stable MS patients.

This meta-analysis evaluated follow-up MRI findings in 1637 patients with Multiple Sclerosis who were clinically stable. The primary objective was to determine the proportion of patients developing at least one new asymptomatic spinal cord lesion. The study highlights the prevalence of spinal cord activity in patients who may appear stable on clinical assessment.

The analysis found that 13.0% (95% confidence interval 6.2-25.1) of clinically stable patients developed at least one new asymptomatic spinal cord lesion. Among patients specifically with relapsing-remitting multiple sclerosis, this proportion was higher at 19.1% (95% confidence interval 13.2-26.7). These findings suggest that spinal cord involvement is a common feature of the disease progression even in stable patients.

A limitation noted by the authors is that isolated spinal cord activity could not be pooled due to heterogeneous definitions and analytic units. Clinicians should note that relying solely on brain MRI for surveillance may result in missing significant spinal cord activity. The results provide a basis for considering more comprehensive imaging protocols in MS management.

How this fits prior evidence

This meta-analysis addresses a gap in monitoring disease activity by highlighting the prevalence of spinal cord lesions in stable patients. While previous evidence has focused on managing symptoms like fatigue and pain through probiotics, or improving mobility via vestibular rehabilitation, this finding emphasizes the importance of comprehensive MRI surveillance. It specifically highlights that spinal cord activity may be missed if clinicians rely only on brain MRI, complementing existing knowledge on MRI markers such as the brain age gap.

Living with multiple sclerosis means constant monitoring of how the disease affects the body. Doctors often rely on brain scans to see if the condition is stable. However, new data suggests that looking only at the brain might miss important activity happening in the spinal cord.

Researchers looked at MRI scans from 1,637 people with stable multiple sclerosis. They found that 13% of these patients developed at least one new asymptomatic spinal cord lesion. This number was even higher, at 19.1%, for those with relapsing-remitting multiple sclerosis. These lesions are areas of damage that do not show immediate symptoms but still indicate activity.

Because of these findings, doctors may need to look closer at the spine during checkups. While the data on isolated spinal cord activity was hard to group together perfectly due to different ways of measuring it, the overall finding is clear. Relying only on brain scans might not give the full picture of what is happening in the body.

What this means for you:
Brain scans alone may not show all the activity occurring in the spinal cord for people with multiple sclerosis.

Common questions

What did the study find about spinal cord activity in MS?

The study found that 13% of patients with stable multiple sclerosis developed at least one new asymptomatic spinal cord lesion. For those with relapsing-remitting multiple sclerosis, that number was higher, at 19.1%. These are areas of activity in the spine that do not show immediate symptoms.

Why is this finding important for doctors and patients?

This finding is important because it suggests that relying only on brain MRI scans might miss activity in the spinal cord. Doctors should be aware that spinal cord activity can occur even when a patient's condition seems stable on a brain scan.

Study Details

Study typeMeta analysis
Sample sizen = 1,637
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
BACKGROUND: Spinal cord lesions are common in Multiple Sclerosis (MS) and contribute to disability, but the frequency of new asymptomatic lesions during follow-up is uncertain. OBJECTIVE: To review new asymptomatic spinal cord lesions (aSCLe), estimate the patient-level proportion developing at least one lesion, and assess isolated spinal cord activity without concomitant brain Magnetic Resonance Imaging (MRI) activity. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. PubMed, Scopus, and Web of Science were searched through May 1, 2026 for studies reporting new aSCLe on follow-up MRI in clinically stable patients with MS (pwMS). According to the criteria used in original papers, MS stability was clinically defined most commonly as the absence of relapses, new neurological symptoms, and/or disability progression during the interval assessed; however, operational definitions varied across studies. The primary outcome was the patient-level proportion developing at least one new lesion. Comparable studies were pooled using a random-effects generalized linear mixed model (GLMM). RESULTS: Nine studies were included in the qualitative synthesis and three in the meta-analysis (1637 patients). The pooled proportion developing at least one new asymptomatic spinal cord lesion was 13.0% (95% confidence interval 6.2-25.1; I² = 96.5%). In relapsing-remitting multiple sclerosis, the pooled estimate was 19.1% (95% confidence interval 13.2-26.7; I² = 79.1%). Isolated spinal cord activity was reported across studies but could not be pooled because of heterogeneous definitions and analytic units. CONCLUSIONS: Available evidence suggests that new asymptomatic spinal cord lesions may occur during clinically stable follow-up in a meaningful proportion of pwMS. Clinicians should recognize that spinal cord activity may be missed when surveillance relies on brain MRI alone. Standardized whole-cord protocols and patient-level reporting are needed to determine prognostic value and implications for treatment escalation.
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