On the grey matter issue. The following is an extract from an article from the UK MS MRI Unit on the UK MS Society website.
We are trying to find markers of prognosis (a prediction of disease progression) early on because this will help decide who will most likely benefit from new treatments. MRI lesion volume has some effect on the long term course but is a relatively weak predictor. We are now investigating other measures that show a more extensive abnormality than just the visible lesions. There are intrinsic abnormalities in the normal appearing white matter and grey matter that show up with measures including magnetisation transfer ratio (MTR) - specific types of MRI scans allowing more precise detection of damage, and MR spectroscopy. There is also loss of tissue in both the white and grey matter.
The following article is also from the UK MS Society website:
Damage in the Grey Matter in Multiple Sclerosis (MS)
March 2005, we look at Professor Margaret Esiri's study of grey matter in MS.
The brain can be divided into grey and white matter. Grey matter is the area where nerve cells communicate with each other. White matter acts as the wiring between different areas of the brain. Traditionally MS researchers focused on damage in the white matter because damage in this area appeared to explain all the characteristic relapsing remitting character of the earlier stages of disease. However, white matter damage cannot explain disability progression in a simple way. It alone also does not easily explain memory problems in MS, which can be found in roughly half of the patients.
Damage in the grey matter in MS provides an alternative explanation for these symptoms. We are interested in investigating changes in the grey matter in MS. Although damage in the grey matter was recognised many years ago, these changes were not widely appreciated. Recent studies have re-examined the grey matter and suggest that we may have underestimated the importance of damage in this area.
A study conducted at our department focused on nerve cells and their junctions in one grey matter area. This work demonstrated that there was a loss of nerve cells and their junctions within damaged grey matter in MS. These observations that nerve cells and their junctions are damaged in MS could help us to explain psychological findings such as memory problems. Our findings could be relevant for new treatments for MS that protect nerve cells and their junctions.
What's not clear is why the grey matter is being damaged. Is it from the inflammation that occurs when the myelin (white matter) is damaged or is there another reason (neuro-degeneration?). Much recent research has revealed that this disease is even worse than first imagined. On the plus, the more the scientists know about it the better they should become at identifying strategies to combat it. By the time they have solved the mystery I will have probably lost so much grey matter that I would have forgotten that I promised to buy you a drink.