Multiple Sclerosis

Multiple Sclerosis and Tumefactive MS

Multiple sclerosis is a condition that attacks the coating of the brain and spinal cord called myelin. When this coating is attacked, it results in multiple scars and lesions on the spinal cord itself. This is what the name refers to. These lesions cause the flow of signals from nerves to the brain to be interrupted and distorted. This then causes the patient to begin suffering the symptoms of the disease.

These symptoms consist largely of physical effects which are easily connected to a nervous disorder. Among many symptoms, patients can suffer with dizziness and imbalance, difficulty in walking and involuntary emotional expression disorder. This last will mean that the patient will exhibit laughter or tears involuntarily and possibly at inappropriate times.

Patients may also suffer from Uhtoff’s phenomena, which is an increased sensitivity to increases in core temperature. Demyelinated nerves are very sensitive, and can cause heat induced muscle weakness. Because this symptom often presents because of a hot environment, such as a hot bath or even just the sun, the weakness can be extreme enough to keep patients from extricating themselves from the environment that is causing the condition.

Optic neuritis can also be a symptom of MS. This is inflammation of the optic nerve and can cause pain with eye movements as well as sudden onset of blurry vision or the complete loss of vision.

MS has a variety of other symptoms as well, ranging from hormonal symptoms in women, to bladder and bowel dysfunction.

tumefactive multiple sclerosis symptoms

In general, MS lesions are quite small. Tumefactive MS is,  however, a very rare form of MS where lesions are 2 cm or more size. These lesions are not only larger but more aggressive than typical MS lesions. Because of their size they can appear as tumors, which is what the name refers to. Sometimes, these large lesions are caused by something other than MS. Generally, they will indicate the presence of the disease, but it is possible that they’ll be a result or cause of something else. It will be important to get the correct diagnosis.

tumefactive multiple sclerosis symptoms

Tumefactive MS has a few symptoms that make it distinct from regular MS. These include:

  • headache
  • seizures
  • brain stem dysfunction
  • language problems (aphasia)
  • cortical sensory loss
  • psychosis

Even with these symptoms, it can be a challenge to distinguish this from standard MS. What will generally be required is an MRI to be able for your doctor to actually look at the lesions. Multiple, small lesions will indicate the presence of regular MS, while fewer, large lesions may indicate tumefactive MS. As already stated, the large lesions can be caused by multiple things, so further investigation with a neurologist will be required.

In order to diagnose tumefactive MS, there will be a large requirement for further investigation with a neurologist. An MRI is just a starting place for this diagnosis, and patients will often need to undergo further testing. This might include a complete neurological exam, a spinal tap, and further blood work. It might also require an examination of evoked potentials. This is the electrical stimulation of the nervous system to test potentials.

This is because the lesions may indicate something other than MS. There are several conditions that may appear as tumefactive MS to begin with.

The first possibility is acute disseminated encephalomyelitis (ADEM). Like MS, this is an inflammatory demyelinating disease. What this means is that it also attacks the myelin, like MS. However, it differs from MS in that it is an autoimmune disorder generally triggered by another infection. Nonetheless, it shares enough similarities that it is treated as a borderline condition of MS.

Another disease that can mimic tumefactive MS is brain abscess. Abscesses are a collection of pus, immune cells, and other material in the brain, usually from a bacterial or fungal infection. They generally occur because of an infection in the brain. The immune system responds to this infection by isolating it. Unfortunately, this can do more harm than good. The immune reaction can easily cause swelling and inflammation which then causes pressure on your brain.

It’s also possible for cancer to present as tumefactive MS. Of concern is metastasized cancer, or cancer that has spread to the brain from another part of the body. Cancer will also produce tumors on the brain.

Central nervous system lymphoma is also a possibility. CNS lymphoma is a rare type of non-Hodgkin lymphoma. This disease also causes brain tumors.

Cerebritis or infection of the brain can be mistaken for tumefactive MS and so can primary brain tumor.

Treatment

Like regular MS, tumefactive MS responds well to high-dosage corticosteroids. These drugs reduce inflammation and may be administered intravenously and through pills. The generic names of the substances used are dexamethasone, methylprednisolone, and prednisone. These drugs are not administered on an ongoing basis, but rather to treat sudden onset attacks of the disease.

There are also ten drugs that can modify the progression of MS called disease modifying medications. None of them provide a cure, but rather, they work to manage the progression of the disease. These can also be used for tumefactive MS.

Patients with MS will also be encouraged to engage in complementary measures such as yoga, massage and meditation.

Relapse-remitting multiple sclerosis

Caught quickly, tumefactive MS responds well to treatment, and progresses into relapse-remitting multiple sclerosis (RRMS). In this form of MS, a patient will suffer attacks of symptoms that last for a few days to several weeks. Between attacks, there will be periods of remission. During these periods, remission is almost complete, and even after twenty years of the disease, there is little accumulation of symptoms or disabilities. This doesn’t mean that the disease is gone, but it will mean that outside of attacks and flare-ups, you won’t suffer because of it.

Further Reading

“Tumefactive Multiple sclerosis.” By Potjana Jitawatanarat, Bhatraphol Tingpej and Paul Deringer. British Journal of Medical Practitioners. http://www.bjmp.org/content/tumefactive-multiple-sclerosis.

“Tumefactive Multiple Sclerosis: Symptoms, Diagnosis, and Treatments.” By Ann Pietrangalo. Healthline.  http://www.healthline.com/health-slideshow/tumefactive-multiple-sclerosis#1.

“About MS.” Multiple Sclerosis Society of Canada. http://mssociety.ca/en/information/default.htm.

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