Diffuse Axonal and Tissue Injury in Patients With Multiple Sclerosis With Low Cerebral Lesion Load and No Disability

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Abstract
MULTIPLE SCLEROSIS (MS) is an inflammatory demyelinating disease of the central nervous system that causes severe clinical disability in young adults. Traditionally, impairment of the central nervous system and the related loss of function have been considered to be largely due to the demyelination and consequent delay or block of electrical conduction by axons that are otherwise substantially preserved. In the past decade, however, in vivo magnetic resonance (MR) spectroscopy (MRS) studies of N-acetylaspartate (NAA)1-5 and in situ postmortem studies6-8 have demonstrated that sparing of axons is only relative in MS and injured or transected axons are a common finding in this disorder. This has led to a reconsideration of the role of axonal injury in MS and, in particular, its relevance to clinical disability.9,10