Balo’s Disease Overview:

While multiple sclerosis typically is a disease that waxes and wanes, Balo Disease is different in that it tends to be rapidly progressive. Symptoms may include headache, seizures, gradual paralysis, involuntary muscle spasms, and cognitive loss.

Balo Disease is a rare and progressive variant of multiple sclerosis. It usually first appears in adulthood, but childhood cases have also been reported. While multiple sclerosis typically is a disease that waxes and wanes, Balo Disease is different in that it tends to be rapidly progressive. Symptoms may include headache, seizures, gradual paralysis, involuntary muscle spasms, and cognitive loss. The alternative names for Balo Disease, concentric sclerosis or Balo concentric sclerosis, refer to the fact that Balo Disease is characterized by bands of intact myelin (the sheath of fatty substances surrounding nerve fibers), alternating with rings of loss of myelin (demyelination), in various parts of the brain and brain stem. The symptoms of Balo Disease vary, according to the areas of the brain that are affected. Symptoms may progress rapidly over several weeks or more slowly over two to three years.

Sometimes called Balo concentric sclerosis this term comes from a pattern of concentric (circular) areas of damaged myelin alternating with areas of relatively undamaged myelin in various parts of the brain and spinal cord. This pattern can be seen on magnetic resonance imaging (MRI).

Other terms for Balo’s disease are: 

  • Concentric Sclerosis
  • Encephalitis Periaxialis Concentrica
  • Leukoencephalitis Periaxialis Concentric

Attacks from Balo’s disease can proceed rapidly over weeks or months, usually without remission (a rapidly progressive course); a relapsing course (periods of symptoms followed by improvement or disappearance of symptoms) can also occur, or a person may experience a single attack (monophasic course).

Interestingly, Balo Disease affects males and females in equal numbers. More cases have been reported from China and the Philippines than elsewhere.

What causes Balo’s disease?

The cause of Balo’s disease is not known, however, some studies indicate that autoimmune factors may play a role in its development. Autoimmune disorders are caused when the body’s natural defenses against “foreign” or invading organisms begin to attack healthy tissue for unknown reasons resulting in inflammation (swelling).

The cause of the recovery witnessed in some patients that have or have not received treatment is also not known.

 

Balos-concentric-sclerosis-MRIHow is Balo’s disease different from MS?

Balo’s disease is sometimes considered a variant of MS because so many of the symptoms are similar to those seen in MS. In Balo’s disease, the unusual, concentric ring pattern seen on MRI images and in tissue specimens is not typically seen in MS.

Standard Therapies:

Treatment is symptomatic and supportive. Corticosteroids are usually useful in decreasing severity of acute presentations through their anti-inflammatory actions. Treatment to relieve symptoms, such as spasticity, weakness, pain, or ataxia, includes pharmacologic and rehabilitative modalities.

What About Disease Modifying Treatments?

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Balos’ concentric sclerosis is quite rare.  A few cases have been reported where disease modifying therapies were applied and appeared to have no impact on progression.  At the sametime there are other reports of Balo’s where other than steroid usage progression of the disease appeared to have ceased.