Well, these aren't MY craters, but they did once belong to someone with multiple sclerosis.
The craters are evidence of the war between one's hyperactive immune system and its target enemy, the central nervous system. As this interior neurochemical warfare takes place inside one's body, the damage takes the form of lesions (or plaques), shredded nerve fibers that, over time, turn into atrophied sections of the brain. Craters.
Also, if you can imagine the coating on a copper wire being damaged, revealing the copper filament inside, then you have an image of the physical proof of the demyelinating process. Demyelination occurs when the outer coatings of our nerves (the myelin sheaths) are eroded away by aggressive immune system attacks, leaving these openings or scars in the coatings. This makes the nerves themselves dysfunction partially or completely.
The reason why those with MS have so many different variations on the disease resides specifically in where these lesions form. If one gets lesions on nerves that operate the bladder, for instance, then the are going to have bladder issues. If one has a problem with word recall and speech? The lesions are probably located in the speech center of their brain.
How are lesions found? MRIs locate active ones as "white spots" when gadolinium contrast dye is injected into the bloodstream during the procedure. An MSer can have active lesions (which are likely the source of their various physical woes) or they can have inactive lesions (basically, scabbed over areas of demyelination). Inactive lesions might be thought of as previously active lesions in remission, with no active inflammation occurring in those areas. A new, actively inflammatory lesion might be detectable for almost 2 months, then develop scar tissue, thereby turning it into an inactive lesion. Here's a great article that really explains the whole active-inactive lesions difference in great detail.
If you've ever wondered why doctors have MSers take annual or even quarterly MRIs, it's because they are tracking the active inflammation in the brain, especially if the MSer is taking a disease modifying therapy (or DMT). These snapshots help to capture the develop of MS "over space and time," which is critical in confirming diagnosis.
The brain does have some capacity to remyelinate, if given the chance. This is why doctors want their patients to be compliant with their DMTs... the theory is that the DMTs will slow the attacks enough that the brain can get in there and work some healing magic. There are drugs currently being examined in large studies in Europe which may effectively arm the brain with this remyelinating magic, which, though not a cure, promises to be a great weapon for any MSer battling the disease. Think of it as filling potholes... not exactly a cure, but usually a serviceable fix.
Some ways to help alleviate the symptoms that are the result of these attacks are more or less good health practices for anybody: eating a healthy diet low in inflammatory foods, exercising, taking supplements that may assist with reducing systemic inflammation, getting enough sleep, drinking water, treating other inflammatory comorbidities like arthritis. These efforts are not going to cure MS or even stop its progression, but they can help relieve symptoms and assist the brain in gearing up to do its healing work when opportunities present themselves during periods of remission (when lesions grow inactive).
