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- Title
Inaugural tumor-like multiple sclerosis: clinical presentation and medium-term outcome in 87 patients.
- Authors
On behalf of the Société Francophone de la Sclérose en Plaques; Michel, L.; Lefrere, F.; Laplaud, D. A.; Derkinderen, P.; Wiertlewski, S.; Balloy, G.; Lejeune, P.; Devos, P.; N'Kendjuo, J.-B.; Coustans, M.; Auffray-Calvier, E.; Daumas-Duport, B.; Brosset, C.; de Seze, J.; Pelletier, J.; Suchet, L.; Lebrun, C.; Cohen, M.; Vermersch, P.
- Abstract
Background: Tumefactive demyelinating lesions of the central nervous system can be the initial presentation in various pathological entities [multiple sclerosis (the most common), Balo’s concentric sclerosis, Schilder’s disease and acute disseminated encephalomyelitis] with overlapping clinical presentation. The aim of our study was to better characterize these patients.Methods: Eighty-seven patients (62 women and 25 men) from different MS centers in France were studied retrospectively. Inclusion criteria were (1) a first clinical event (2) MRI showing one or more large demyelinating lesions (20 mm or more in diameter) with mass-like features. Patients with a previous demyelinating event (i.e. confirmed multiple sclerosis) were excluded.Results: Mean age at onset was 26 years. The most common initial symptoms (67% of the patients) were hemiparesis or hemiplegia. Aphasia, headache and cognitive disturbances (i.e. atypical symptoms for demyelinating diseases) were observed in 15, 18 and 15% of patients, respectively. The mean largest diameter of the tumefactive lesions was 26.9 mm, with gadolinium enhancement in 66 patients (81%). Twenty-one patients (24%) had a single tumefactive lesion. During follow-up (median time 5.7 years) 4 patients died, 70 patients improved or remained stable and 12 worsened. 86% of patients received initial corticosteroid treatment, and 73% received disease-modifying therapy subsequently. EDSS at the end of the follow-up was 2.4 ± 2.6 (mean ± SD).Conclusion: This study provides further evidence that the clinical course of MS presenting with large focal tumor-like lesions does not differ from that of classical relapsing-remitting MS, once the noisy first relapsing occurred.
- Subjects
TISSUE wounds; CENTRAL nervous system; MULTIPLE sclerosis; PATIENTS; HEMIPARESIS
- Publication
Journal of Neurology, 2018, Vol 265, Issue 10, p2251
- ISSN
0340-5354
- Publication type
Article
- DOI
10.1007/s00415-018-8984-7