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Abstract Details

Natural Course of Relapsing Tumefactive Multiple Sclerosis and Tumefactive Demyelinating Lesions
Multiple Sclerosis
P16 - Poster Session 16 (5:30 PM-6:30 PM)
9-018
To determine the natural course,treatment responses,and long-term follow-up of patients with TDL and relapsing TMS in our clinic.

Tumefactive multiple sclerosis(TMS) or tumefactive demyelinating lesion(TDL) is a rare variant of multiple sclerosis(MS),and it is difficult to differentiate from the central nervous system(CNS) neoplasms in magnetic resonance imaging(MRI).Although intravenous methylprednisolone(IVMP) treatment is important,disease-modifying therapies(DMTs) are of importance for patients fulfilling the McDonald MS criteria.                   

Clinical,imaging,and laboratory characteristics,treatment responses and Expanded Disease Status Scale(EDSS) scores of 23 patients with TDL and relapsing TMS followed up in our clinic(1992-2019) were retrospectively analyzed.Brain and spinal cord MRIs were performed in 23 patients.Cerebrospinal fluid(CSF)analysis were done in 21 patients.2 patients were underwent brain biopsy.
Eighteen(78%) of the patients were female and 5(21%) were male.There were 5 childhood-onset patients.Eighteen of the patients(78%) were diagnosed as relapsing-remitting MS(RRMS) and 3(13%) were diagnosed with a single attack MS.Two patients presented with the clinically isolated syndrome. The mean follow-up was 5.7(2-20) years. The initial symptoms of the disease were limb weakness(73%,n=17),epileptic seizures(17%,n=4).Oligoclonal bands(OCBs) were detected in 23%(n=5) of the 21 patients in CSF but not serum,and were normal in 42%(n=9).All patients received IVMP treatment in the acute phase.DMTs were started 56%(n=13) of the patients.Interferon beta,glatiramer acetate,and natalizumab were used as DMT agents.Ocrelizumab was preferred in 1 patient with childhood-onset.The median of the current EDSS score was 2.0(1.0-6.0).
Tumefactive relapsing demiyelinating diseases are an uncommon inflammatory neurological disease with characteristic radiological findings.Differential diagnosis and treatment approaches are important because of response to corticosteroid and DMTs treatment.Some of the patients develop TDLs during the RRMS,but small group of patients shows recurrent TDLs without classical MS findings and these patients might be a different group in the inflammatory demiyelinating diseases spectrum.Further,multicenter,larger,prospective,long-term studies of the patients with relapsing TDLs would be most informative and useful for better understanding of these clinical pictures.
Authors/Disclosures
Ozgu Kizek, MD (Istanbul Faculty of Medicine, Istanbul University)
PRESENTER 		Dr. Kizek has nothing to disclose.
No disclosure on file
Tuncay Gunduz, MD (ISTANBUL UNIVERSITESI NOROLOJI SERVISI) The institution of Dr. Gunduz has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis Pharmaceuticals. Dr. Gunduz has received research support from Turkish Neuroimmunology Society.
Murat Kurtuncu, MD (Istanbul University) Dr. Kurtuncu has nothing to disclose.
Mefkure Eraksoy, MD (ISTANBUL UNIVERSITY) Dr. Eraksoy has nothing to disclose.