Paramagnetic rim lesions are associated with greater incidence of relapse and worse cognitive recovery following relapse

Background: Paramagnetic rim lesions (PRL) may be linked to relapse risk of people with relapsing–remitting multiple sclerosis (pwRRMS). Objective: To determine the relationship between presence of PRL lesions and cognitive recovery after relapse. Methods: PRL load was compared between acutely relapsing pwRRMS and matched stable pwRRMS controls (each group n = 21). In addition, cognitive recovery was compared between acutely relapsing pwRRMS with at least one PRL (PRL+) and those without any PRL (PRL−). Results: Acutely relapsing pwRRMS had significantly greater prevalence and number of PRL (p = 0.004 and p = 0.003) compared with stable controls. These findings remained significant after adjusting for global neuroinflammatory burden (enhancing and non-enhancing lesions). In addition, acutely relapsing PRL + pwRRMS (n = 10) had worse recovery of verbal memory following relapse compared with acutely relapsing PRL − pwRRMS (n = 7; p = 0.027). Conclusion: These findings may partially explain previously suggested associations between presence of PRL with more severe disease course.