Multiple sclerosis is an autoimmune disease that is characterized by two or more lesions in the brain or on the spinal cord, that causes a variety of symptoms including muscle weakness, vision problems, tingling and numbness in the extremities, and loss of balance. The signs and symptoms of MS will depend on where the lesions are found in the brain or on the spinal cord.
The type of MS where one or more of the lesions may resemble a brain tumor is called Tumefactive Multiple Sclerosis. This form of the disease is characterized when the swollen brain lesion(s) reaches a size greater than 2 cm. It may also be characterized if groupings of the lesions produce a mass effect, edema, or ring enhancement. One difference with tumefactive MS is that it typically has a c-shaped outer ring versus an unbroken outer ring or o-shape as is found in most tumors or abscesses.
Another name for Tumefactive Multiple Sclerosis is Pseudotumoral Multiple Sclerosis. This form of MS is vary rare, believed to occur in less than two cases for each one thousand cases of multiple sclerosis.
Signs and Symptoms of Tumefactive Multiple Sclerosis
The list of signs and symptoms for Tumefactive MS starts with tumor like brain lesions. This is a swollen area of the brain that is larger than 2 cm. These lesions would show up on an MRI of the brain. A second symptom of this type of MS is Aphasia, which is the inability to speak or comprehend language.
There may be several neurological symptoms, which are defined as any symptoms caused by neurological conditions. These symptoms are many and varied but can include:
- The inability to complete a known task
- Memory issues
- Forms of dementia
- Seizures
- Mood Swings
- Erratic Behavior
TMS presents a diagnostic challenge to doctors as it can clinically present itself as similar to a brain tumor. The radiographic features are also similar to tumors or cerebral abscesses.
Tumefactive Multiple Sclerosis Treatment
TMS is treated as any type of MS. There is no cure for this disease, yet there are ways to treat exacerbations, which could be considered a sudden attack, relapse, or flare-up. Sometimes these exacerbations cause a patient to seek emergency room care. There are treatment that can change the course of the disease, allow the symptoms to be managed, improve patients’ safety and ability to function, as well as to provide emotional support for someone with MS.
In an emergency situation for those with TMS or any type of MS, it is critical to relieve the risk factors if the symptoms threaten life. At this point it is important to stabilize the patient, which could require taking precautions to prevent seizures and initiating supportive care that may include respiration. The patient may also require monitoring for intracranial pressure. A new treatment known as emergent plasmapheresis may also be considered. This is a process where plasma is separated from whole blood and what is left is returned to the patient.
If the patient suffers from infection, these will be aggressively treated with antibiotics. Because even a minor fever can cause issues with multiple sclerosis, body temperatures will be normalized with the use of antipyretics.
Symptom management is a little tricky as the symptoms cover such a wide range and no two cases of MS are completely alike. Strategies to treat MS symptoms, including that of TMS include:
- Medication - There are medications for nausea, fatigue, itching, to fight infections, and more
- Rehabilitation - This could be physical rehabilitation, occupational or vocational therapy, speech or language therapy, cognitive remediation therapy, and others
- Personal care techniques that include stress management and diet
- Assistive Devices which can include wheelchairs, walkers, or breathing devices
Biopsies can be done to verify that the lesion is not a tumor. There are many reported cases where surgery was done because TMS was mistaken for a brain tumor. Surgery is not used as a treatment for TMS and it is important that you feel confident with your doctor’s diagnosis or get a second, or even third, opinion.
Summary
TMS is a very rare form of Multiple Sclerosis. There isn’t very much available to read on the subject, even on the internet. But it is treated as all other forms of the disease are and the symptoms often mirror the more common forms of the disease. For more information on multiple Sclerosis visit the National MS Society.
TMS is diagnosed with the help of an MRI, when one or more of the lesions associated with the disease are bigger than 2 cm in size. The treatment for what is often shortened to TMS mirrors treatment for other forms of multiple sclerosis. A biopsy of the lesion or what is thought to be a tumor is often done to verify diagnosis of TMS.