Irreversible Disability and Tissue Loss in Multiple Sclerosis

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Abstract
THE FACTORS leading to irreversible neurologic disability in multiple sclerosis (MS) are still poorly understood because of the heterogeneity of the pathologic substrates of the disease and the structural and functional complexity of the brain and the spinal cord. In this context, the optic nerve (ON) is of special interest, because it might provide a model for improving our understanding of how MS causes irreversible disability. There are several reasons for this. First, the ON is a typical site of MS lesions.1 Second, and different from what happens for other structures of the central nervous system, the ON subserves a specific function, which can be assessed reliably by clinical and neurophysiologic methods.2,3 Finally, several recent studies4-10 have shown that magnetic resonance (MR) imaging techniques enable us not only to obtain high-quality images of the ON, but also to quantify reliably the extent of ON tissue damage and loss.