Tumefactive Multiple Sclerosis

Tumefactive multiple sclerosis is a rare form of multiple sclerosis (MS) with symptoms similar to those of a brain tumor. On magnetic resonance imaging (MRI) scans, the condition appears as tumor-like lesions larger than two centimeters.

Multiple sclerosis, is a disease of the central nervous system (CNS), which is comprised of the brain, spinal cord and optic nerve. 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 CNS, causing a reduction or loss of body function. In many cases, the axons are also destroyed.

Symptoms

Symptoms of tumefactive multiple sclerosis often are not typical of general multiple sclerosis symptoms.

Tumefactive MS symptoms may include:

  • Headaches
  • Cognitive abnormalities
  • Mental confusion
  • Difficulty understanding and forming speech, known as aphasia
  • Difficulty with the movement patterns needed to produce speech, known as apraxia
  • Seizures
  • Weakness

 

Causes and Risk Factors

Tumefactive multiple sclerosis is rare and its cause is unknown.

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 multiple sclerosis later in life suggests that there may be environmental factors at work in the disease.

Diagnosis

Diagnosis begins with a detailed medical history and neurological examination. Tumefactive multiple sclerosis can have symptoms similar to those of brain tumors, and diagnostic tests are used to 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. Since MRI results can be similar to what is seen with brain tumors, a biopsy may be performed to aid in diagnosing the condition.

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.

Tumefactive multiple sclerosis is often misdiagnosed as a brain tumor, most commonly astrocytoma brain tumors.

Treatments

There is no cure for tumefactive multiple sclerosis, and the majority of cases develop into the relapsing-remitting variant of the disease.

If RRMS develops after a tumefactive MS episode, certain medications may be used to reduce the frequency and severity of relapse episodes a patient experiences. There are several FDA approved medications available that have been shown to decrease disease activity in the brain and spinal cord. These medications include some that are given as injections under the skin or into the muscle, as intravenous infusions, and as pills taken orally. Determining the best treatment for your condition is best done after a thorough evaluation and discussion of risks and benefits with your neurologist.

Other medications may address specific symptoms such as:

  • Depression
  • Muscle spasms
  • Need for frequent urination

Symptoms of tumefactive MS can affect a patient's daily life and physical and occupational therapy may be used to manage symptoms.

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.