Baló’s concentric sclerosis in the pediatric population: literature review and analysis of clinical cases in the context of follow up observation

Abstract

Baló’s concentric sclerosis is a rare variant of atypical pseudotumor demyelination, having a pathogenetic similarity with multiple sclerosis and a characteristic neuroimaging pattern with relative clinical heterogeneity. In children and adolescents, Baló’s concentric sclerosis even rarer than in adults, is represented in the scientific literature by single descriptions of clinical cases with a polymorphic clinical phenotype and various anamnestic prerequisites (for example, infectious). Moreover, the published cases do not involve the analysis of a long-term clinical following up in children and adolescents with this pathology, possibly due to their transition to adult neurological services as they grow up. This sample does not allow the analysis of cases of Baló’s concentric sclerosis with pediatric debuts and answer questions about the clinical features and therapeutic needs for such patients. Especially a lot of questions have accumulated concerning approaches to the treatment of patients with the classical, mono-focal form of Baló’s concentric sclerosis. The lack of scientific and clinical information hinders the adoption of administrative decisions on prescribing drugs from the PITRS group (drugs that change the course of multiple sclerosis) to such patients. To replenish the literature base of pediatric cases of Baló’s concentric sclerosis, we analyzed the Russian experience of long-term (from 2 to 6 years) curation of three juvenile patients with acute non-infectious demyelinating episode and monofocal concentric lesion of the white matter of the brain. Russian data demonstrate the long-term efficacy and tolerability of drugs from the PITRS group among pediatric patients with Baló’s concentric sclerosis.