A separate piece of work recently done by Keegan and colleagues that was published in Multiple Sclerosis Journal , looked at their own cohort of patients that had at least one critically located lesion, typically in the high cervical spinal cord or the lower brain stem, as being the crucial driver of the development of motor dysfunction and progressive disability.
In an editorial I wrote with my colleague, Fred Lublin, called “ Location, location, location ,” we point out that this is in some ways the best data in support of the concept of the topographical model that I have seen. It outlines a framework or a methodology where the importance of lesion location in defining the clinical picture and the risk of progression for an individual patient can be studied.