Peripheral Nervous System Involvement in Demyelinating Disorders

Demyelinating disorders have traditionally been viewed through the lens of central nervous system pathology, yet growing evidence highlights substantial peripheral nervous system (PNS) involvement across multiple conditions. In multiple sclerosis (MS), for example, electrophysiological and imaging studies reveal demyelination and axonal changes in peripheral nerves that parallel central lesions. Similar patterns have emerged in neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), where concurrent PNS pathology may manifest as sensory deficits, cranial neuropathies or radiculitis. These peripheral manifestations appear to reflect both direct autoimmune attack on Schwann cell myelin and secondary changes in the extracellular matrix. Advanced imaging methods, such as magnetic resonance neurography, have provided non-invasive biomarkers to map microstructural alterations along the length of peripheral nerves, revealing proximal-to-distal gradients and individual variability. Recognition of PNS involvement has practical implications for differential diagnosis, therapeutic targeting and monitoring of disease progression across idiopathic and antibody-mediated demyelinating syndromes.

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Peripheral Nervous System Involvement in Demyelinating Disorders publication trend

The graph below shows the total number of articles in peripheral nervous system involvement in demyelinating disorders across all publications each year (not limited to Nature Index journals).

Technical terms

Demyelination: Loss or damage of the insulating myelin sheath surrounding nerve fibres, impairing signal conduction.

Peripheral Nervous System (PNS): The network of nerves outside the brain and spinal cord that transmits sensory and motor signals.

Magnetic Resonance Neurography (MRN): An imaging technique optimised to visualise peripheral nerve structure and pathology in vivo.

T2 relaxation time (T2app): An MRI parameter reflecting the decay of transverse magnetisation, sensitive to tissue water content and myelin integrity.

Proton Spin Density (PSD): A quantitative MRI measure of hydrogen proton concentration, indicative of microstructural tissue changes.

Myelin Oligodendrocyte Glycoprotein (MOG): A protein component of central myelin; autoantibodies against MOG are implicated in demyelinating syndromes affecting both CNS and PNS.

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP): An autoimmune disorder characterised by progressive peripheral nerve demyelination, leading to weakness and sensory loss.

References

1. Abnormal Nerve Conduction Study Findings Indicating the Existence of Peripheral Neuropathy in Multiple Sclerosis and Neuromyelitis Optica. BioMed Research International (2013).
2. Quantification and Proximal-to-Distal Distribution Pattern of Tibial Nerve Lesions in Relapsing-Remitting Multiple Sclerosis. Clinical Neuroradiology (2022).
3. AQP4-MOG Double-Positive Neuromyelitis Optica Spectrum Disorder: Case Report with Central and Peripheral Nervous System Involvement and Review of Literature. International Journal of Molecular Sciences (2022).
4. Evolution of peripheral nerve changes in early multiple sclerosis—a longitudinal MR neurography study. Frontiers in Neurology (2024).
5. Combined Central and Peripheral Demyelination (CCPD) Associated with MOG Antibodies: Report of Four New Cases and Narrative Review of the Literature. Journal of Clinical Medicine (2024).