What is tumefactive MS?

Tumefactive multiple sclerosis is a rare form of multiple sclerosis that involves a mass in the brain. It may look similar to a number of other conditions, including cancerous tumors and tuberculomas.

Multiple sclerosis (MS) is a disease that affects the body's central nervous system and the nerves' protective myelin sheath.

The myelin sheath conducts electrical signals and protects the nerves. In people with MS, the myelin sheath is scarred. This damage causes areas of plaques and lesions and leads to nerve fiber damage and the loss of certain functions.

When the myelin sheath is damaged or completely broken, the electrical impulses sent from the brain to the muscles do not work properly.

Contents of this article:

1. What is tumefactive MS?
2. Symptoms
3. Causes and risk factors
4. Diagnosis
5. Treatment
6. Outlook

What is tumefactive MS?

Tumefactive multiple sclerosis is a rare form of MS. It is sometimes confused with a brain tumor, cancer, or an infection.

During diagnosis, tumefactive MS may look similar to a brain tumor, brain abscess, tuberculoma, primary Sjögren syndrome, sarcoidosis, or other inflammatory conditions.

Symptoms

Tumefactive MS is characterized by the presence of a mass in the brain, which may be identified during an MRI scan.
Image credit: The Armed Forces Institute of Pathology, (2008, July 2).

Those with tumefactive MS may experience symptoms that are unusual to the more general MS condition.

Symptoms specific to tumefactive MS include:

• headaches
• confusion
• changes in cognition
• difficulty speaking and understanding speech
• seizures
• weakness
• nausea and vomiting

More general symptoms of MS include:

• fatigue and weakness
• numbness and tingling
• difficulty walking
• stiffness, involuntary muscle spasms, or tremors
• blurred vision, changes in color vision, and eye movement pain
• dizziness, lightheadedness, and vertigo
• bladder dysfunction
• sexual dysfunction
• constipation and bowel incontinence
• pain

Someone with MS can also have changes in their problem-solving abilities, focus, perception, and their ability to learn and retain new information

Causes and risk factors

Being related to someone with MS may increase the risk of developing tumefactive MS.

While the cause of tumefactive MS is not fully understood, genetics and environmental factorsmay play a role in how the disease develops.

Children of people with MS are believed to be at a higher risk of developing MS themselves.

Other risk factors for developing MS include:

• being aged 20 to 50 years old
• being a woman, specifically of Northern European ancestry
• living far away from the equator
• having a parent, sibling or identical twin with MS

One theory suggests that bacterial or viral infections can cause MS, although there is insufficient evidence to support this.

Diagnosis

Diagnosing tumefactive MS poses many challenges for doctors because it can be confused with other medical conditions, including brain tumors, cancer, infections, or other diseases.

Due to this similarity with other medical conditions, several tests may be necessary to confirm tumefactive MS and to rule out other life-threatening conditions.

These diagnostic tests include:

• magnetic resonance imaging (MRI)
• brain biopsy
• spinal tap or lumbar puncture
• certain nerve function tests
• blood tests

Those with tumefactive MS have one or more brain lesions larger than 2 centimeters in diameter, in addition to swelling in the brain or cerebral edema.

A person may also experience mass effect, which is the effect a lesion has on surrounding brain tissues. Mass effect can cause nausea, drowsiness, headaches, visual disturbances, and even behavioral changes.

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Treatment

Intravenous medications may be used to treat tumefactive MS.

There is currently no cure for tumefactive MS. Many of those affected by it will go on to develop a variation of MS called relapsing-remitting MS or RRMS.

People with RRMS experience periods of relapse and remission. This means they will experience periods of no symptoms during remission but will have new or returning symptoms during a relapse.

While there is not always a clear cause for the relapse, there are several things that may trigger one. These include:

• stress
• pregnancy
• vaccinations
• infections

Some people make a full recovery after a relapse, while others will experience lingering symptoms.

There are some medications available to decrease the frequency of RRMS relapses.

Injectable medications include:

• Avonex (interferon beta-1a)
• Betaseron (interferon beta-1b)
• Copaxone (glatiramer acetate)
• Extavia (interferon beta-1b)
• Glatiramer acetate injection
• Plegridy (peginterferon beta-1a)
• Rebif (interferon beta-1a)
• Zinbryta (daclizumab)

Oral medications include:

• Aubagio (teriflunomide)
• Gilenya (fingolimod)
• Tecfidera (dimethyl fumarate)

Infused medications, which are taken intravenously, include:

• Lemtrada (alemtuzumab)
• Novantrone (mitoxantrone)
• Ocrevus (ocrelizumab)
• Tysabri (natalizumab)

Other medications may be recommended based on a person's symptoms, situation, and medical history.

Severe relapses may be treated with high doses of intravenous corticosteroids. These can be used for a short time only to reduce severe symptoms, such as loss of vision, extreme weakness, or loss of mobility.

Symptoms during a relapse may also be managed with the use of physical therapy and lifestyle changes so that a person can maintain their everyday activities.

Lifestyle changes that may be helpful in managing the symptoms of RRMS include eating a healthful diet free of processed foods, doing stretching and flexibility exercises, and practicing relaxation techniques, such as deep-breathing and meditation.

Outlook

Tumefactive MS can be difficult to diagnose, as it is easily mistaken for brain tumors and other conditions. Anyone experiencing the symptoms of MS should see a doctor, as soon as possible.

While there is no cure for tumefactive MS or RRMS, there is a range of treatments available to help ease the symptoms.