Fulminate Multiple Sclerosis

Multiple Sclerosis (MS) is a disease of the central nervous system (CNS), which is made up of the brain, spinal cord and optic nerve. When the condition rapidly progresses, it is known as an acute form of the condition called fulminant multiple sclerosis. This condition is sometimes referred to as Marburg-type MS .

This disorder causes destruction of the coating (myelin) that surrounds and protects nerve fibers (axons). As a result, the damage disrupts the normal flow of messages (nerve impulses) from the central nervous system, causing a reduction or loss of body function. In many cases, the axons are also destroyed.

Symptoms

Symptoms of fulminant MS are similar to those of relapsing-remitting multiple sclerosis (RRMS). The main difference between the two conditions is speed. Fulminant MS develops rapidly, while RRMS can develop over the course of many years. Symptoms include:

  • Fatigue
  • Numbness or tingling in feet or hands
  • Vision problems, such as temporary blindness or double vision
  • Spasticity or stiffness
  • Bowel and bladder problems, such as urgent need for urination
  • Problems with cognition, such as learning and memory or information processing
  • Weakness

Patients may experience these symptoms suddenly and without much warning. After the first onset of symptoms, patients generally experience more relapse episodes and rapid deterioration of their neurological and physical abilities over a short period of time.

 

Causes and Risk Factors

The cause of fulminant MS is unknown, and the condition itself is still relatively uncommon. The condition appears to mostly affect children and young adults.

Since the risk of multiple sclerosis is significantly higher when a parent has been diagnosed with the disease, genetic factors may play a role. The unusual relationship between a person's geographic location during childhood and the risk of MS later in life suggests that there may be environmental factors at work in the disease.

Diagnosis

Diagnosis of all forms of MS begins with the taking of a detailed medical history and performing a neurological examination. Because MS can have symptoms similar to those of other nervous system disorders, diagnostic tests will help rule out other causes and confirm a diagnosis. These tests may include a magnetic resonance imaging (MRI) scan of the brain and spinal cord. The patient's medical team may order a lumbar puncture, also known as a spinal tap, and cerebrospinal fluid analysis, as well as nerve function tests. Blood tests may be performed to rule out other conditions that have similar symptoms.

A biopsy of the brain may be performed in order to evaluate the level of degeneration affecting the myelin. During a biopsy, a small amount of the damaged tissue is taken and analyzed under a microscope.

Treatments

There is no cure for fulminant MS. When a patient has a fulminant MS relapse episode, corticosteroids can be given to shorten and lessen the severity of the relapse. Symptoms of fulminant MS can affect a patient’s daily life and physical and occupational therapy may be used to manage symptoms and help a patient adjust to living and working situations.

Certain medications may be used to reduce the frequency and severity of relapse episodes a patient experiences. Interferon beta medications have been approved by the FDA to treat relapsing-remitting forms of MS. These medications are injected into the muscle and aid in reducing inflammation.

Other medications may be prescribed to address specific symptoms such as:

  • Depression
  • Muscle spasms
  • Need for frequent urination
  • Erectile dysfunction

Choosing the right treatment requires careful consideration of the risks and benefits, along with close collaboration with an experienced neurologist with experience in treating the disease, such as those at the Multiple Sclerosis Center in Cedars-Sinai's Department of Neurology.