Balo’s concentric sclerosis. A lecture describing six clinical cases

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Abstract

Balo’s concentric sclerosis (BCS) is a rare demyelinating disorder. The article analyzes six BCS cases diagnosed using magnetic resonance imaging, clinical data, and cerebrospinal fluid studies. The goal is to differentiate BCS from multiple sclerosis (MS), assess prognosis, and evaluate therapy. Patients exhibited concentric demyelination lesions. In two cases, oligoclonal antibodies were absent (type 1, typical for BCS), while others showed type 2 (more common in MS). Treatment included corticosteroids, plasmapheresis, and anti-B-cell therapy. Disease course varied: some patients had a monophasic course, while others experienced relapsing symptoms resembling pseudotumoral MS. Magnetic resonance imaging showed lesion reduction, but some patients retained neurological deficits.

BCS may be a distinct nosological entity but requires careful differentiation from MS. Early imaging and cerebrospinal fluid analysis are crucial for diagnosis. MS-like therapy is effective, but further research is needed.

About the authors

А. А. Benidze

Medical and Rehabilitation Center “Dubna”, Federal Scientific and Clinical Center for Medical Rehabilitation and Balneology
of the Federal Medical and Biological Agency of Russia

Email: fake@neicon.ru
ORCID iD: 0000-0002-6846-7876

5 Pravdy St., Dubna 141981

Russian Federation

А. S. Kotov

M.F. Vladimirsky Moscow Regional Research Clinical Institute

Email: fake@neicon.ru
ORCID iD: 0000-0003-2988-5706

61/2 Shchepkina St., Moscow 129110

Russian Federation

E. O. Ovchinnikova

M.F. Vladimirsky Moscow Regional Research Clinical Institute

Email: fake@neicon.ru
ORCID iD: 0009-0001-1864-2381

61/2 Shchepkina St., Moscow 129110

Russian Federation

S. A. Syanov

M.F. Vladimirsky Moscow Regional Research Clinical Institute

Author for correspondence.
Email: stepansyanov177@gmail.com
ORCID iD: 0009-0009-1715-3971

Stepan Aleksandrovich Syanov

61/2 Shchepkina St., Moscow 129110

Russian Federation

A. N. Peshkin

M.F. Vladimirsky Moscow Regional Research Clinical Institute

Email: fake@neicon.ru
ORCID iD: 0009-0009-9726-7679

61/2 Shchepkina St., Moscow 129110

Russian Federation

References

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  2. Carta S., Ferraro D., Ferrari S. et al. Oligoclonal bands: Clinical utility and interpretation cues. Crit Rev Clin Lab Sci 2022;59(6):391–404. doi: 10.1080/10408363.2022.2039591
  3. Jarius S., Würthwein C., Behrens J.R. et al. Baló’s concentric sclerosis is immunologically distinct from multiple sclerosis: Results from retrospective analysis of almost 150 lumbar punctures. J Neuroinflammation 2018;15(1):22. doi: 10.1186/s12974-017-1043-y
  4. Jolliffe E.A., Guo Y., Hardy T.A. et al. Clinical and radiologic features, pathology, and treatment of Baló concentric sclerosis. Neurology 2021;97(4):414–22. doi: 10.1212/WNL.0000000000012230
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  6. Siemerling E., Creutzfeldt H.G. Bronzekrankheit und sklerosierende Encephalomyelitis. Arch Psychiatr Nervenkr 1923;68:217–44. doi: 10.1007/BF01835678
  7. Stadelmann C., Ludwin S., Tabira T. et al. Tissue preconditioning may explain concentric lesions in Baló’s type of multiple sclerosis. Brain 2005;128(5):979–87. doi: 10.1093/brain/awh457
  8. Tzanetakos D., Vakrakou A.G., Tzartos J.S. et al. Heterogeneity of Baló’s concentric sclerosis: A study of eight cases with different therapeutic concepts. BMC Neurol 2020;20(1):400. doi: 10.1186/s12883-020-01971-2

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