There are distinct patterns of structural damage and reorganization in the brains of patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), found a new study published in the journal Multiple Sclerosis and Related Disorders. According to the authors of the study, these findings could help differentiate between the 2 diseases. 

To explore the changes in brain volume and structure in MS and NMOSD, a team of researchers from China analyzed 40 patients with MS, 35 patients with NMOSD, and 34 healthy volunteers.

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The participants all underwent a 3-dimensional T1-weighted image and T2 FLAIR of magnetic resonance imaging. Using automated brain volumetry, the researchers compared the volumes of subcortical brain regions of patients with MS, NMOSD, and healthy controls.

Then, they analyzed the changes in anatomical connections in the brains of patients with MS and NMOSD compared to healthy controls.

The results showed that some subcortical and infratentorial regions of the brain of patients with MS were significantly smaller in volume compared to healthy controls. On the other hand, there were no significant volumetry differences in any of the brain regions of  patients with NMOSD. 

However, the researchers found synergic volume changes in the subcortical regions of the brain in both MS and NMOSD patients. In the brain of patients with MS, there were more extensive additional connections than in the brain of healthy controls while in the brains of patients with NMOSD, there were more extensive missing connections compared to healthy controls.

These findings, the researchers said, “may reveal different underlying pathophysiology of the 2 diseases.”

MS and NMOSD are rare chronic inflammatory diseases of the central nervous system that share clinical features. However, they are 2 different entities; MS is characterized by the presence of autoantibodies against the myelin sheath surrounding the nerve cells while in most cases of NMOSD, there are autoantibodies against the aquaporin-4 water channel.


Xie Y, Zhang Y, Yao Y, et al. Structural covariance in subcortical regions in multiple sclerosis and neuromyelitis optica spectrum disorders: an MRI-based study with automated brain volumetry. Mult Scler Relat Disord. Published online January 14, 2023. doi:10.1016/j.msard.2023.104516