Multiple sclerosis (MS) is well-established as being a highly heterogeneous disease, and now part of this heterogeneity can be better explained by the discovery of a new MS subtype characterized by the absence of demyelination in cerebral white matter.1 This discovery was made using the rapid brain donation program at Cleveland Clinic, which involves in situ MRI followed by pathological examination of the brain within six hours of death.

We and our collaborators found that 12 of 100 cases of MS received for brain donation had no cerebral white matter demyelination but did have loss of myelin in the cerebral cortex and spinal cord, prompting us to name this new subtype myelocortical multiple sclerosis (MCMS) (Figure 1). We then conducted a comparative study between the 12 patients with MCMS and 12 cases of typical MS matched by age, sex, MRI protocol, MS disease subtype, disease duration and Expanded Disability Status Scale score.

Illustration of the thought processes in the brain

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