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Silhouette image of a person with a shrinking brain.

Shrinkage! Brain Atrophy and MS

Is there any symptom of Multiple Sclerosis that is scarier than brain atrophy? The literal shrinking of our brains. I guess that depends on who you talk to, but, for me, the idea that my brain is shrinking is absolutely terrifying. Some people may not even be aware that this seldom talked about symptom can occur in those with MS. In fact, after seeing some folks debate it online, I thought I’d bring it up to clear up some misconceptions.

Our brains shrink?

While it’s scary to think about, once you reach adulthood, everyone’s brain shrinks, whether you have a neurological disease or not.1 However, people with Multiple Sclerosis can experience brain atrophy at an accelerated rate (sometimes up to ten times as fast as those without MS). When you stop and think about it, it’s really not that surprising that those with MS can experience faster than normal brain atrophy. After all, MS causes our own immune system to attack and eat away at the myelin, the protective insulation surrounding our nerves. That damaged myelin is going to mean that our overall brain volume (another term commonly used for assessing the size of our brain) will lessen. So, obviously, the more progressive the MS, the greater the chances and speed of brain atrophy.

This is bad, right?

Well, as you might expect, brain atrophy isn’t the greatest symptom that MS has to offer. In fact, it’s one of the possible causes of cognitive dysfunction among those with Multiple Sclerosis. However, cognitive problems are not the only issue with brain volume loss. Brain shrinkage can affect a large number of areas and has been a good measure in determining not only the severity of one’s MS, but also in their overall level of disability. Brain atrophy is essentially a good indicator in the overall decline of an MS patient.2

Fighting it

Battling the normal brain atrophy we encounter with aging is possible, with a “use it or lose it strategy”, in other words, exercising your brain (puzzles, reading, keeping your brain active). While that same strategy is vital when fighting against cognitive dysfunction in MS, it can take a bit more to protect us against brain shrinkage. Protecting against brain volume loss is an important thing to think about when discussing your treatment plan with your doctor, as some medications are better than others at slowing the rate of brain atrophy. Regular exercise has also shown some benefits with regards to combating shrinkage.3 Tracking brain volume loss is also a good way to evaluate whether your current treatment plan is effective (it can actually be tracked via MRI with the use of special software).4

Talk to your MS specialist

As revealed at an ECTRIMS (European Committee for the Treatment and Research of Multiple Sclerosis) conference, a recent study has shown that many MS patients do not have significant knowledge about brain atrophy and its effects on them, despite the fact that “Brain atrophy is increasingly being used as an outcome measure in MS clinical trials and is strongly correlated with the development of disability and neuropsychological impairment”.5 Those findings very much confirm what I’ve seen in discussions among those with MS, that people simply don’t know enough about the effects of brain atrophy with regards to their disease. The best way to remedy that is to discuss it with your doctor. I encourage everyone to ask their doctor about this topic, if your medication aids in the protection against atrophy, and if atrophy is something they are measuring.

Thanks for reading!


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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Peters R. Ageing and the brain. Postgrad Med J. 2006;82(964):84-8.
  2. Radue E-W, Barkhof F, Kappos L, et al. Correlation between brain volume loss and clinical and MRI outcomes in multiple sclerosis. Neurology. 2015;84(8):784-793. doi:10.1212/wnl.0000000000001281.
  3. Kunzmann K, Kaltwasser J. Study: Exercise Combats Multiple Sclerosis Brain Atrophy. MD Magazine. Published August 6, 2017. Accessed February 21, 2019.
  4. Zivadinov R, Jakimovski D, Gandhi S, et al. Clinical relevance of brain atrophy assessment in multiple sclerosis. Implications for its use in a clinical routine. Expert Review of Neurotherapeutics. 2016;16(7):777-793. doi:10.1080/14737175.2016.1181543.
  5. Montague A, R. Bakshi R. Brain atrophy in multiple sclerosis: how patients understand the role of brain atrophy in the management of their MS. Poster presented at: ECTRIMS; October 10, 2018; Berlin, Germany.


  • Artanis12
    8 months ago

    “Tracking brain volume loss is also a good way to evaluate whether your current treatment plan is effective (it can actually be tracked via MRI with the use of special software).”

    Come on Devin, you and I both know this is NOT happening at the level of the dr’s office. No, real doctors (such as my own) are tossing out weasel-phrases that imply that “meds are now being shown to reduce shrinkage back to age-matched controls” while not saying exactly WHICH meds have been evaluated that way, a pretty important distinction if you ask me. I can promise you it isn’t the bulk of the good old standards like copaxone, or even something like Tecfidera. I looked long and hard for any literature that Tec reduced brain shrinkage and could find none. (Perhaps I need a refresher in using pubmed, but still) I even went to Biogen’s Tecfidera pages and read the clinician’s pages, and no claims for shrinkage reduction. They’d be shouting it from the roof tops if they had shown it, but crickets.

    What I get from all this, other than dr’s scaring patients with something that they pretty much know about but can’t stop for the most part, is that unless you’re straddling the bleeding edge of the latest MS blockbuster med (with commensurately blockbuster side-effects) then worrying about brain shrinkage is a waste of your already overburdened worry allotment.

  • Meglette63
    8 months ago

    My $.02 + experiential knowledge
    The brain, like almost every other part of the body, responds to misuse, and non-use. I hate to use the cliche, but if you don’t use it, you lose it. Case in point (not MS but brain related) My mom, (not an MS pt.) has lost her hearing, and hearing related comprehension. It shows on her MRI that the part of her brain that is hearing/understanding geared has shrunk! Not only that but there is shrinkage in the areas around those atrophied hearing areas. Frightening! if you ask me.
    My thought is to use my brain to do what ever I can, and hasn’t done before. I have picked my piano practicing again. I am trying French again. I am writing, and organizing and drawing.
    Thanks for reading.

  • Devin Garlit moderator author
    8 months ago

    Thank you @Meglette63, it’s absolutely beneficial to use it. Just like physical therapy and speech therapy can be vital to those with MS, doing some for of cognitive therapy is essential (in my mind).

  • potter
    8 months ago

    I had two aunts who had MS before there was any treatments for it. One of my aunts had such severe symptoms she had to move to assisted living when she was 32. She died from brain shrinkage when she was 50. She suffered from dementia then her organs started to shut down. When I was first diagnosed I immediately asked for a DMT to help prevent brain shrinkage. I mentioned this on another MS forum and I got a response from the administrator that I wasn’t to talk about brain shrinkage. She wrote that even though it was true it would scare other MSers. I had never read anything about brain shrinkage on any of the MS sites and thought people should know about it. I am glad you are bringing up the subject. Potter

  • Devin Garlit moderator author
    8 months ago

    Thanks so much @potter, I hate to hear that another site censored the topic. There are many things about MS that can be scary, those things are always scarier if you don’t talk about them, if you don’t confront them and educate yourself.

  • @masbrautigam
    8 months ago

    I am happy about this article because it’s one area i sm not so familiar with, even after reading about it.
    Thanks for your great explanation on this. I wonder why our neurologist don’t bring this up?
    It’s a scary thing.

  • Devin Garlit moderator author
    8 months ago

    Thanks so much @mascha!

  • Dimitri
    8 months ago

    Great topic. I too think this topic does not get the attention it deserves. There was an interesting article about this on Barts MS. Neurologist’s aim to achieve NEDA (No Evident Disease Activity) by measuring inflammation, lesion load on the MRI. But MS Specialists were saying that this is not good enough, because even with NEDA the brain still atrophying.

    So what should neurologists be aiming to achieve?

  • Devin Garlit moderator author
    8 months ago

    Thank you @Dimitri! It is certainly an interesting topic because even if you maintain no evident disease activity and don’t concern yourself with increased atrophy, what becomes of that down the line? In my mind, increased atrophy is still an issue to be concerned with.

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