In the last decade or so, we have seen numerous major advances in our understanding of multiple sclerosis (MS). While the condition was traditionally viewed as a disease of the brain white matter, this hypothesis has been turned on its head with the discovery that grey matter involvement occurs in MS. Furthermore, we now know that this can happen quite early in the disease course and that it may underlie physical disability. A lot of MS patients report cognitive changes that occur even in the earliest stages of the disease and it is very possible that these changes may be due to the loss of grey matter.

In the current issue of JNNP, Haider and colleagues present a very interesting study that demonstrates that involvement of the deep grey matter may play an important role in the development of disability in MS http://jnnp.bmj.com/content/85/12/1386.abstract . In addition, they also show that these changes were associated with accumulation of iron in the brain. This is a very important finding as iron has been postulated to play a role in the development of brain oxidative injury.

This is a very interesting study which provides important insights into our understanding of the pathology of MS.