Damage to the cerebellum in people with multiple sclerosis (MS) is due more to the death of actual nerve cells than the destruction of white matter connections, a new study out of Italy suggests. The article, which challenges previous ideas about how brain damage in MS occurs, is titled “MRI-detectable cortical lesions in the cerebellum and their clinical relevance in multiple sclerosis“ and appeared in Multiple Sclerosis Journal.

MS is characterized by lesions on white matter, in what known as the loss of myelin. This means that the insulating substance that wraps around neurons is damaged, impairing communication within the nervous system and causing symptoms such as loss of movement, coordination and vision, tingling sensations, and even cognitive and emotional problems. White matter lesions have been a focus of MS research and treatment, but increasing evidence points to cells being lost in MS as well. In the cerebellum, this cell loss is known as cortical lesions.

The cerebellum, found in the back of the cerebral cortex, is like a “mini-brain” for coordination and smooth movement. Although neurologists tend to focus on MS lesions in the cerebral cortex, lesions in the cerebellum may also be important. However, these lesions can be hard to detect, due to the cerebellum’s physical location.

Scientists led by Alice Favaretto, of the Department of Neurosciences DNS, The Multiple Sclerosis Centre–Veneto Region, University Hospital of Padova, Italy, studied a total of 40 people with relapsing-remitting MS (RRMS). The team found that cortical lesions (the kind in which damaged neurons are found) were more common in the cerebellum than white matter lesions. In addition, cortical cerebellum lesions could be used to predict the level of disability in people with MS.

Cortical lesions (CL) “are detected by PSIR [phase-sensitive inversion recovery] in the cerebellum of the majority of MS patients, are more than WML [white matter lesions], increase with disease progression and strongly correlate with the cerebellar EDSS [expanded disability status scale]. Thus, the observation of CL in the cerebellum of MS at clinical onset might be useful for prognostic and therapeutic aims,” the scientists wrote.

This research indicated that cerebellar cortical lesions are clinically relevant, and may be important for neurologists to monitor in evaluating MS disease progression and disability.