Can chronic inactive lesions cause problems like balance and vision issues?

Here is My Question:
Can chronic inactive lesions still cause problems and can these problems get worse? My balance is getting worse as are my eyes. Thanks

Answer:
There is no sure way at present to differentiate chronic inactive from chronic active MS lesions during life with a tissue biopsy. These terms are pathological descriptions without a definite correlate on MR imaging. That said, there are many ways for MS to progressively worsen in those individuals who do not appear to show any changes on MR imaging over many years.  Examples of ways in which MS can worsen over time despite no change on standard MR imaging of the brain or spinal cord include the following:

1. Progressive demyelination and axonal injury in the spinal cord. The spinal cord, particularly the thoracic spinal cord, is difficult to image and detect enlarging or new lesions during the progressive phase. Accurate measurements can usually detect atrophy of sections of the spinal cord, but this is not done in standard practice.
2. The demyelination is occurring in the cerebral cortex. Demyelination in the cortex is not visible at all with standard imaging techniques
3. The worsening is due to progressive axonal transaction or energy failure in chronic lesions on MR imaging. This often takes years to become visible
4. The worsening is due to widespread synaptic or axonal injury in gray matter or white matter networks that appear normal on MRI
5. The worsening could be due to the normal aging process superimposed on prior damage from MS. Remember, our brains normally atrophy at a rate of 0.1 to 0.2 percent per year in health individuals. If there is already damage from years of MS, this further rate of "normal" age related atrophy will become more apparent because of exceeding the threshold of neurological reserve.

I'm sure I could think of other reasons, but these are the most important. Some people take an over-the-counter supplement, Alpha lipoic acid (600 mg twice a day), to help prevent further injury and deterioration from inflammatory stress in the nervous system. There are some very preliminary studies suggesting this may be helpful.

Good luck

Revere P (Rip) Kinkel, MDProfessor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego​