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Multicenter Study
. 2021 Apr;28(4):1299-1307.
doi: 10.1111/ene.14672. Epub 2021 Jan 12.

Defining the course of tumefactive multiple sclerosis: A large retrospective multicentre study

Maria Di Gregorio  1   2 , Valentina Liliana Adriana Torri Clerici  3 , Giuseppe Fenu  4   5 , Lorenzo Gaetani  1 , Antonio Gallo  6 , Paola Cavalla  7 , Paolo Ragonese  8 , Pietro Annovazzi  9 , Alberto Gajofatto  10 , Luca Prosperini  11 , Doriana Landi  12   13 , Carolina Gabri Nicoletti  12   13 , Caterina Di Carmine  14 , Rocco Totaro  14 , Viviana Nociti  15 , Chiara De Fino  15 , Diana Ferraro  16 , Valentina Tomassini  17   18   19   20 , Carla Tortorella  11 , Isabella Righini  21 , Maria Pia Amato  22   23 , Alessia Manni  24 , Damiano Paolicelli  24 , Pietro Iaffaldano  24 , Roberta Lanzillo  25 , Marcello Moccia  25   26 , Fabio Buttari  27 , Roberta Fantozzi  27 , Raffaella Cerqua  28 , Sara Zagaglia  29   30 , Deborah Farina  18 , Giovanna De Luca  18 , Maria Chiara Buscarinu  31 , Federica Pinardi  32 , Eleonora Cocco  4   5 , Claudio Gasperini  11 , Claudio Marcello Solaro  33 , Massimiliano Di Filippo  1
Affiliations
Multicenter Study

Defining the course of tumefactive multiple sclerosis: A large retrospective multicentre study

Maria Di Gregorio et al. Eur J Neurol. 2021 Apr.

Abstract

Background and purpose: Tumefactive multiple sclerosis (TuMS) (i.e., MS onset presenting with tumefactive demyelinating lesions [TDLs]) is a diagnostic and therapeutic challenge. We performed a multicentre retrospective study to describe the clinical characteristics and the prognostic factors of TuMS.

Methods: One hundred two TuMS patients were included in this retrospective study. Demographic, clinical, magnetic resonance imaging (MRI), laboratory data and treatment choices were collected.

Results: TuMS was found to affect women more than men (female:male: 2.4), with a young adulthood onset (median age: 29.5 years, range: 11-68 years, interquartile range [IQR]: 38 years). At onset, 52% of TuMS patients presented with the involvement of more than one functional system and 24.5% of them with multiple TDLs. TDLs most frequently presented with an infiltrative MRI pattern (38.7%). Cerebrospinal fluid immunoglobulin G oligoclonal bands were often demonstrated (76.6%). In 25.3% of the cases, more than one acute-phase treatment was administered, and almost one-half of the patients (46.6%) were treated with high-efficacy treatments. After a median follow-up of 2.3 years (range: 0.1-10.7 years, IQR: 3.4 years), the median Expanded Disability Status Scale (EDSS) score was 1.5 (range: 0-7, IQR: 2). Independent risk factors for reaching an EDSS score ≥3 were a higher age at onset (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.03-1.14, p < 0.01), a higher number of TDLs (OR: 1.67, 95% CI: 1.02-2.74, p < 0.05) and the presence of infiltrative TDLs (OR: 3.34, 95% CI: 1.18-9.5, p < 0.001) at baseline.

Conclusions: The management of TuMS might be challenging because of its peculiar characteristics. Large prospective studies could help to define the clinical characteristics and the best treatment algorithms for people with TuMS.

Keywords: Multiple sclerosis; Tumefactive demyelinating lesions; Tumefactive multiple sclerosis; differential diagnosis.

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References

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