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The puzzle of multiple sclerosis: gray matter finds its place

Evaluation of: Roosendaal SD, Bendfeldt K, Vrenken H et al. Grey matter volume in a large cohort of MS patients: relation to MRI parameters and disability. Mult. Scler. 17(9), 1098–1106 (2011). The way we think of multiple sclerosis (MS) pathology has significantly changed over the last 10 years. Several studies clearly indicate that MS has to be considered a gray and white matter disease, where gray matter pathology probably plays a relevant role in determining physical and cognitive disability. The reviewed article presents new cross-sectional data on gray matter and white matter volumes across different MS phenotypes in a very large group of MS patients. In their study, the authors confirm an early and substantial deterioration of gray matter in MS and the evidence of a primary role of gray matter atrophy in the progression of clinical and cognitive disability. Another preliminary exciting step has therefore been taken toward the comprehension of the MS puzzle.