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. 2025 Oct 21;272(11):717.
doi: 10.1007/s00415-025-13431-3.

Cervical cord atrophy correlates with intracranial lesion burden in tumefactive multiple sclerosis

Albert Aboseif  1   2 , Caitlin S Jackson-Tarlton  1   3 , Christopher G Schwarz  4 , Paul A Decker  5 , Matthew L Kosel  5 , Jiye Son  4 , B Mark Keegan  1   2 , Kejal Kantarci  4 , Jeanette E Eckel-Passow  5 , Orhun H Kantarci  1   2 , Burcu Zeydan  1   4 , W Oliver Tobin  6   7
Affiliations

Cervical cord atrophy correlates with intracranial lesion burden in tumefactive multiple sclerosis

Albert Aboseif et al. J Neurol. .

Abstract

Background: Spinal cord atrophy associates with motor disability in multiple sclerosis (MS). The influence of intracranial lesion burden (ILB) on spinal cord atrophy requires further investigation. Tumefactive MS (TMS) offers a model for studying the contribution of ILB on spinal cord atrophy.

Objectives: Determine the relationship between upper cervical cord (UCC) area, ILB, and progressive TMS.

Methods: Individuals with tumefactive demyelinating disease (TDD) undergoing UCC area analysis (C1-C3) were stratified into three groups based on ILB: single-lesion (SL-TDD), multiple-lesion (ML-TDD), and tumefactive MS (TMS). Descriptive characteristics and UCC area were compared across radiological and clinical phenotypes.

Results: Of 109 individuals, six (6%) were SL-TDD, 28 (26%) ML-TDD, and 75 (69%) TMS. All seven (6%) with progressive MS met TMS criteria. TMS had more spinal cord (63% vs. 26%; p = 0.003), and lateral tract lesions (54% vs. 14%; p = 0.001), and a higher final EDSS [median 2.5 (IQR 1.5,3.0) vs. 2.0 (0.0,2.0); p = 0.01] than ML-TDD. After excluding individuals with UCC lesions, there was an inverse trend between median C2 area and ILB across groups: SL-TDD, 56.3 mm2 (47.9,69.0); ML-TDD, 53.4 mm2 (37.2,63.2), and TMS, 50.8 mm2 (32.0,64.3); p = 0.08.

Conclusions: During the course of TMS, early disability may be driven by a single tumefactive lesion while late disability is related to the accrual of intracranial lesions, spinal cord disease, and UCC atrophy. Across the TMS spectrum, there appears to be an inverse relationship between UCC area and ILB, partially independent of UCC lesions which trended towards statistical significance, warranting further investigation.

Keywords: Atrophy; Demyelinating disease; Disability; Lesion burden; Spinal cord; Upper Cervical Cord (UCC).

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Conflict of interest statement

Declarations. Conflicts of interest: Albert Aboseif is sponsored by the Eugene and Marcia Applebaum Fellowship Award through the Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic. Caitlin S. Jackson-Tarlton reports consulting/advisory for EMD Serono, Novartis, Roche, Biogen, Amgen Horizon, and clinical trial support from Roche. Christopher G. Schwarz receives research funding from NIH. Paul A. Decker reports no disclosures. Matthew L. Kosel reports no disclosures. B. Mark Keegan reports consulting for EMD Serono, Tr1X, Inc, Moderna, royalties from Oxford University Press Mayo Clinic Cases in Neuroimmunology. Kejal Kantarci serves on the Data Safety Monitoring Board for Takeda Pharmaceuticals. She is funded by the National Institutes of Health. Jeanette E. Eckel-Passow reports no disclosures Orhun H. Kantarci reports no disclosures. Burcu Zeydan receives funding from the National Institutes of Health [K12 AR084222]. W. Oliver Tobin has received research grant funding from the National Institutes of Health, the Mayo Clinic Center for MS and Autoimmune Neurology and book royalties from the publication of Mayo Clinic Cases in Neuroimmunology (Mayo Clinic Scientific Press) 2022.

Figures

Fig. 1
Fig. 1
Methodological approach to stratifying individuals by tumefactive demyelinating disease
Fig. 2
Fig. 2
The radiological spectrum of tumefactive demyelinating disease including single-lesion tumefactive demyelinating disease (SL-TDD; 1 A – 4B); multi-lesion tumefactive demyelinating disease (ML-TDD; 5A-6B), and tumefactive multiple sclerosis (TMS; 7 A – 8B)
Fig. 3
Fig. 3
C2 area analysis excluding UCC lesions across individuals with a single lesion vs. multiple lesions (A), fulfillment of dissemination in space (B), and across the TMS spectrum (C)
See this image and copyright information in PMC

References

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