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Understanding Tumefactive Multiple Sclerosis

Updated on March 11, 2021
Medically reviewed by
Amit M. Shelat, D.O.
Article written by
Alexia Williams, Ph.D.

Tumefactive multiple sclerosis (MS), also known as Balo’s concentric sclerosis or Balo’s disease, is a rare form of MS with symptoms resembling those of a brain tumor. According to an article in the Journal of Chiropractic Medicine, less than 1 percent of all MS cases are diagnosed as tumefactive MS.

Tumefactive MS typically appears as one or more large brain masses, or lesions, in imaging studies. Such symptoms are not associated with other forms of MS. For this reason, tumefactive MS is frequently misdiagnosed. As with many rare diseases, the direct cause of tumefactive MS is not known or understood.

Symptoms of Tumefactive Multiple Sclerosis

Tumefactive MS symptoms are very different from the most common forms of MS. Typical MS symptoms include:

  • Fatigue
  • Numbness
  • Dizziness
  • Difficulty walking
  • Changes in vision
  • Bladder and bowel problems
  • Sexual problems
  • Pain

Additional physical symptoms of tumefactive MS can include:

  • Headaches
  • Seizures
  • Weakness
  • Balancing problems
  • Muscle spasms

Moreover, people with tumefactive MS may experience cognitive impairments including:

  • Confusion and memory issues
  • Difficulty learning new concepts
  • Aphasia, or difficulty understanding and forming speech
  • Apraxia, or difficulty making the movements needed for speech
Has your MS progressed to another type? Go here to learn all about MS types.

How Is Tumefactive Multiple Sclerosis Diagnosed?

Tumefactive MS is diagnosed in several ways. A doctor will first order a medical history and a neurological exam. Additional tests may then be performed to detect unusual growths; damage to the brain, nerve, spinal cord, or brain stem; or the presence of inflammatory diseases or infections. These tests can also rule out other conditions.

These tests may include:

  • MRI scans of the brain or spinal cord
  • Biopsies of brain lesions
  • Blood tests
  • Nerve function tests
  • Analysis of cerebrospinal fluid from a spinal tap
  • Evoked potential testing, a diagnostic tool that measures how long it takes for one’s nerves to respond to stimulation

Because people with tumefactive MS present with atypical symptoms, it’s often misdiagnosed as other conditions including:

  • Brain tumors
  • Brain cancers
  • Brain abscesses
  • Tuberculoma
  • Other disorders of the central nervous system, such as Sjögren’s syndrome or sarcoidosis

For this reason, people with tumefactive MS may be repeatedly misdiagnosed, leading to a delay in treatment.

How Does Tumefactive Multiple Sclerosis Differ From Other Types of MS?

There are several key differences between tumefactive MS and other forms of MS:

  • Lesions from tumefactive MS appear as large tumors in MRI scans. They are often shaped differently than lesions from other MS types, and they are typically larger, measuring more than 2 centimeters in diameter.
  • Tumefactive MS can result in alternating ring patterns of damaged and undamaged myelin in the brain and spinal cord. These demyelination rings, observable through an MRI scan, are not found in other forms of MS.
  • Tumefactive MS brain lesions often resemble malignant brain cancers, such as glioma, astrocytoma, or lymphoma, as well as cerebral abscesses.

Is Tumefactive Multiple Sclerosis Progressive?

Unlike other forms of MS, tumefactive MS generally progresses rapidly. Disease progression can occur in several ways:

  • Rapidly progressive course — The disease proceeds rapidly over weeks or months with no signs of remission.
  • Relapsing course — The person with tumefactive MS experiences periods of symptom improvement (or without any symptoms), followed by recurrence.
  • Monophasic course — In this type of progression, a person may experience only a single attack of tumefactive MS, followed by no symptoms.

Most cases of tumefactive MS develop into relapsing-remitting MS (RRMS). RRMS is the most common form of MS, affecting about 80 percent to 85 percent of people with the disease.

Does Tumefactive Multiple Sclerosis Cause Disability?

According to the National Multiple Sclerosis Society, tumefactive MS can worsen over time and lead to severe disability, both physical and cognitive. Not every case of tumefactive MS results in severe disabilities. Some people have reported spontaneous remission of tumefactive MS without the presence of any symptoms.

What Causes Tumefactive Multiple Sclerosis?

The cause of tumefactive MS is not known. However, the disease has attributes that may point to other contributing factors.

Mass Effect

Case reports show that tumefactive MS brain masses sometimes cause what’s called mass effect, which occurs when the masses affect multiple surrounding brain regions simultaneously. Mass effect is likely responsible for many tumefactive MS symptoms.

Inflammation

Because tumefactive MS is considered an inflammatory demyelinating disease, some scientists theorize that its cause may be rooted in autoimmune disorders.

Treatments for Tumefactive Multiple Sclerosis

As with other forms of MS, there’s no single progression path. A variety of treatments can help people with tumefactive MS manage symptoms and slow the progression of the illness. Medications can be taken orally, via injections, or administered intravenously.

Corticosteroids

Corticosteroids are commonly used in tumefactive MS to decrease the severity of inflammation in affected regions of the brain or spinal cord. This form of MS responds particularly well to corticosteroids.

Therapeutic Plasma Exchange

Therapeutic plasma exchange is commonly used to alleviate certain blood, neurological, or autoimmune disorders. Some diseases can result in an abnormal substance in the blood. Therapeutic plasma exchange replaces damaged plasma with plasma free of abnormalities, which can help slow the disease’s progression and relieve symptoms.

Intravenous Immunoglobulin

Intravenous immunoglobulin is used as a third-line treatment for different forms of MS. This therapy entails injecting a mixture of antibodies into a muscle, a vein, or under the skin, which helps people with immunodeficiencies fight off a large variety of infections.

Specialized Rehabilitation

Rehabilitation can help those with physical ailments from tumefactive MS to manage weakness or imbalance. Physical, speech, or occupational therapy may be especially helpful.

Lifestyle Changes

Lifestyle changes, such as daily exercise, movement routines, or relaxation techniques such as yoga and meditation may help reduce symptom severity.

Hear From Others Who Understand

MyMSTeam is the social network and online support group for people living with multiple sclerosis and their loved ones. On MyMSTeam, more than 188,000 people come together to ask questions, give advice, and share their stories with others who understand life with MS.

Have you been diagnosed with tumefactive MS? How has it affected your life? Share your experience in the comments below, or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Alexia Williams, Ph.D. is a behavioral and molecular neuroscientist who studies the molecular basis of psychiatric disorders. Learn more about her here.

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