Balo Concentric Sclerosis
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Baló's concentric sclerosis is a disease in which the white matter of the brain appears damaged in concentric layers, leaving the axis cylinder intact. It was described by
József Mátyás Baló József Mátyás Baló (10 November 1895 – 9 October 1979) was a Hungarian physician and academic. He researched extensively into neurological conditions, cardiovascular conditions and with his wife isolated the enzyme elastase. He published nu ...
who initially named it "leuko-encephalitis periaxialis concentrica" from the previous definition, and it is currently considered one of the borderline forms of multiple sclerosis. Baló's concentric sclerosis is classified as an inflammatory demyelinating disorder of the
central nervous system The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity o ...
, distinguished from classical multiple sclerosis by the characteristic formation of concentric rings of
demyelination A demyelinating disease refers to any disease affecting the nervous system where the myelin sheath surrounding neurons is damaged. This damage disrupts the transmission of signals through the affected nerves, resulting in a decrease in their con ...
alternating with preserved myelin. Although earlier reports suggested that the prognosis resembled that of Marburg variant multiple sclerosis, more recent case series and reviews have described patients experiencing more favorable outcomes, including asymptomatic periods, spontaneous remission, or prolonged disease stability. Cases of Baló's concentric sclerosis have been observed to follow a range of courses, with the majority showing a single acute phase, while others demonstrate either a relapsing-remitting pattern or progression similar to aggressive forms of multiple sclerosis. Although historically considered rare, with fewer than 1% of multiple sclerosis cases showing the characteristic ring-shaped demyelination pattern, Baló's concentric sclerosis is now recognized globally, rather than being geographically confined to Asian populations as once believed. The concentric ring appearance is not specific to Baló's concentric sclerosis. Concentric lesions have also been reported in patients with
neuromyelitis optica Neuromyelitis optica spectrum disorders (NMOSD) are a spectrum of autoimmune diseases characterized by acute inflammation of the optic nerve (optic neuritis, ON) and the spinal cord ( myelitis).Banerjee S, Butcher R. Rituximab for the Treatment o ...
, standard multiple sclerosis,
progressive multifocal leukoencephalopathy Progressive multifocal leukoencephalopathy (PML) is a rare and often fatal viral disease characterized by progressive damage (''-pathy'') or inflammation of the white matter (''leuko-'') of the brain (''-encephalo-'') at multiple locations (''mu ...
, cerebral autosomal dominant arteriopathy with subcortical infarcts, leukoencephalopathy, concomitant active hepatitis C and human herpes virus 6.


History

Although the disease is most commonly associated with the work of Hungarian pathologist
József Mátyás Baló József Mátyás Baló (10 November 1895 – 9 October 1979) was a Hungarian physician and academic. He researched extensively into neurological conditions, cardiovascular conditions and with his wife isolated the enzyme elastase. He published nu ...
, the first descriptions of concentric demyelinating lesions were provided by
Otto Marburg Otto Marburg (May 25, 1874 – June 13, 1948) was an Austrian neurologist known for his contributions to the understanding of multiple sclerosis and for advances in neurooncology. Marburg was born in Römerstadt in Moravia, Austria-Hungary ( ...
in 1906, who documented cases presenting with rapidly progressive neurological decline and distinctive histopathological findings. During much of the 20th century, Baló's concentric sclerosis was considered a rare and often fatal demyelinating disease, closely linked to tumefactive variants of multiple sclerosis. The disease was characterized by rapidly progressive neurological decline and distinctive concentric demyelinating lesions, leading to its classification as a variant of multiple sclerosis. However, evolving pathological and imaging studies have since suggested that BCS represents a distinct clinicopathological entity within the broader spectrum of demyelinating diseases.


Pathophysiology

The lesions of the Baló's sclerosis belong to the MS lesion pattern III (distal oligodendrogliopathy). Balo concentric sclerosis is now believed to be a variant of pattern III multiple sclerosis probably due to immune problems. The Baló lesions show veins at their center, like those of MS, some suggestive of microhemorrhages or small ectatic venules. Unlike MS, no cortical gray matter lesions appear. Evidence from immunopathological studies suggest that, unlike other MS subtypes where demyelination is diffuse, the pathological hallmark of Baló lesions is the presence of sharply defined alternating layers of demyelinated and myelin-preserved tissue, indicative of a distinct pattern of immune-mediated attack combined with hypoxia-like stress. Histopathological investigations have observed that these lesions often contain a central vein and display organized concentric rings, supporting the view that vascular factors and microcirculatory impairment might play a role in their formation.


Theoretical Model

Mitochondrial dysfunction, particularly involving impaired
complex IV The enzyme cytochrome c oxidase or Complex IV (was , now reclassified as a translocasEC 7.1.1.9 is a large transmembrane protein complex found in bacteria, archaea, and the mitochondria of eukaryotes. It is the last enzyme in the respiratory ele ...
activity within the respiratory chain, has also been proposed as a contributing factor to tissue damage in Baló lesions, where such deficits may exacerbate axonal injury through glutamate-mediated excitotoxic mechanisms similar to those identified in pattern III multiple sclerosis lesions. This expression and counter-expression forms rings of preserved tissue within the lesion and rings of demyelinated tissue just beyond where the previous attack had induced the protective stress proteins. Hence, subsequent attacks form concentric rings. Support for this model comes from findings of increased expression of heat shock proteins such as HSP70 and hypoxia-inducible factors (HIF-1α) in Baló lesions, which are believed to protect surrounding tissue and promote survival of axons and glial cells within the demyelinated areas. These stress responses may allow for periods of remission or tissue recovery in certain patients. In parallel to these hypoxia-related mechanisms, researchers have emphasized the potential role of
mitochondrial dysfunction Mitochondrial disease is a group of disorders caused by mitochondrial dysfunction. Mitochondria are the organelles that generate energy for the cell and are found in every cell of the human body except red blood cells. They convert the energy of ...
in lesion development. In particular, reduced activity of
complex IV The enzyme cytochrome c oxidase or Complex IV (was , now reclassified as a translocasEC 7.1.1.9 is a large transmembrane protein complex found in bacteria, archaea, and the mitochondria of eukaryotes. It is the last enzyme in the respiratory ele ...
or the respiratory chain has been proposed to result in cellular energy deficits that amplify glutamate-mediated excitotoxic injury, a process also recognized in pattern III multiple sclerosis lesions. Studies suggest that the survival of
astrocyte Astrocytes (from Ancient Greek , , "star" and , , "cavity", "cell"), also known collectively as astroglia, are characteristic star-shaped glial cells in the brain and spinal cord. They perform many functions, including biochemical control of en ...
s within lesions may also contribute to the potential for remyelination, as preserved astrocytic function and support oligodendrocyte precursor cells and restore water balance in the affected tissue. This recovery capacity has been highlighted in case reports of Baló disease patients showing substantial neurological improvement over time without aggressive immunotherapy. This model is questioned by recent reports that found
astrocyte Astrocytes (from Ancient Greek , , "star" and , , "cavity", "cell"), also known collectively as astroglia, are characteristic star-shaped glial cells in the brain and spinal cord. They perform many functions, including biochemical control of en ...
damage, similar to the one found in
aquaporin Aquaporins, also called water channels, are channel proteins from a larger family of major intrinsic proteins that form pores in the membrane of biological cells, mainly facilitating transport of water between cells. The cell membranes of ...
-seropositive
neuromyelitis optica Neuromyelitis optica spectrum disorders (NMOSD) are a spectrum of autoimmune diseases characterized by acute inflammation of the optic nerve (optic neuritis, ON) and the spinal cord ( myelitis).Banerjee S, Butcher R. Rituximab for the Treatment o ...
. Though no anti-NMO antibodies have been found, the damage is similar, pointing to problems in the water channel of the astrocytes. Recent observations of aquaporin-4 and aquaporin-1 depletion within Baló lesions even in the absence of detectable antibodies, suggests astrocytic injury plays a more role in the pathogenesis than previously thought.


Other Models

A mathematical model for concentric sclerosis has been proposed. Authors review the previous pathogenic theories, discuss the link between concentric sclerosis and Liesegang's periodic precipitation phenomenon and propose a new mechanism based on self-organization. This model proposes that the layered pattern of Baló lesions may emerge from physicochemical self-organization processes within the damaged brain tissue, similar to Liesegang ring formation in chemistry, where periodic precipitation patterns result from reaction-diffusion mechanisms.


Clinical courses

More recent observations of Baló's concentric sclerosis describe a wider spectrum of clinical presentations, including relapsing-remitting and monophasic forms. While the disease can progress aggressively, several case reports have documented patients with prolonged stability or spontaneous remission, even in the absence of disease-modifying therapy. High-dose corticosteroid therapy such as
intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutr ...
methylprednisolone Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol) is a synthetic glucocorticoid, primarily prescribed for its anti-inflammatory and immunosuppressive effects. It is either used at low doses for chronic illnesses or used at high doses durin ...
, is often used during acute episodes, but its efficacy in altering the long-term course of Baló's concentric sclerosis remains unclear due to a lack of controlled trials and the confounding occurrence of spontaneous improvement. The variable response to
corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are invo ...
s further highlights the unpredictable nature of Baló's concentric sclerosis. Baló lesions can undergo radiological resolution over time, particularly in monophasic cases, yet some patients experience evolution to relapsing-remitting multiple sclerosis (RRMS), underscoring the potential for disease progression despite initial remission. Based on clinical observations, Baló's concentric sclerosis has been categorized into three
phenotypic In genetics, the phenotype () is the set of observable characteristics or traits of an organism. The term covers the organism's morphology (physical form and structure), its developmental processes, its biochemical and physiological propert ...
patterns: monophasic, relapsing-remitting, and primary progressive forms. Cerebrospinal fluid (CSF) studies in Baló's concentric sclerosis typically show normal findings or mild mononuclear pleocytosis. Unlike classical Multiple sclerosis, CSF-restricted
oligoclonal band Oligoclonal bands (OCBs) are bands of immunoglobulins that are seen when a patient's blood serum, or cerebrospinal fluid (CSF) is analyzed. They are used in the diagnosis of various neurological and blood diseases. Oligoclonal bands are present in ...
s are identified only in a minority of cases, emphasizing the immunological differences between Baló's concentric sclerosis and multiple sclerosis. The presence or absence of oligoclonal bands, as well as the clinical subtype at presentation does not consistently predict disease outcome, as some monophasic cases may remit spontaneously while others progress despite treatment. The behavior of Baló lesions is also influenced by the disease context in which they occur. These lesions have been reported in patients with
aquaporin-4 Aquaporin-4, also known as AQP-4, is a water channel protein encoded by the ''AQP4'' gene in humans. AQP-4 belongs to the aquaporin family of integral membrane proteins that conduct water through the cell membrane. A limited number of aquaporins ...
seropositive and seronegative neuromyelitis optical spectrum disorder (
NMOSD Neuromyelitis optica spectrum disorders (NMOSD) are a spectrum of autoimmune diseases characterized by acute inflammation of the optic nerve (optic neuritis, ON) and the spinal cord (myelitis).Banerjee S, Butcher R. Rituximab for the Treatment of ...
), where they may coexist with
optic neuritis Optic neuritis (ON) is a debilitating condition that is defined as inflammation of cranial nerve II which results in disruption of the neurologic pathways that allow visual sensory information received by the retina to be able to be transmitted to ...
or longitudinally extensive
transverse myelitis Transverse myelitis (TM) is a rare neurological condition wherein the spinal cord is Inflammation, inflamed. The adjective ''wikt:transverse#Adjective, transverse'' implies that the spinal inflammation (myelitis) extends horizontally throughout ...
.


Diagnosis

Baló's concentric sclerosis is primarily diagnosed through characteristic findings on
magnetic resonance imaging Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and ...
(MRI), supported by
cerebrospinal fluid Cerebrospinal fluid (CSF) is a clear, colorless Extracellular fluid#Transcellular fluid, transcellular body fluid found within the meninges, meningeal tissue that surrounds the vertebrate brain and spinal cord, and in the ventricular system, ven ...
(CSF) analysis and, in some cases, histopathological evaluation. The hallmark radiological feature is the appearance of concentric layers of demyelinated and preserved white matter, producing alternating hyperintense and hypointense bands on T2-weighted and FLAIR sequences. These lesions are typically large and tumefactive, often located in the cerebral hemispheric white matter, particularly the frontal and parietal lobes, but can also involve the corpus callosum, brainstem, or spinal cord. Use of high-field 7-Tesla MRI has further refined lesion visualization, often revealing a central vein within Baló lesions, which supports the view of a perivenular pathogenesis similar to classical MS.
Magnetic resonance spectroscopy Nuclear magnetic resonance spectroscopy, most commonly known as NMR spectroscopy or magnetic resonance spectroscopy (MRS), is a spectroscopic technique based on re-orientation of atomic nuclei with non-zero nuclear spins in an external magnetic fi ...
(MRS) has demonstrated increased lactate and decreased N-acetylaspartate within Baló lesions, indicating active inflammation and neuronal loss, while
diffusion tensor imaging Diffusion-weighted magnetic resonance imaging (DWI or DW-MRI) is the use of specific MRI sequences as well as software that generates images from the resulting data that uses the diffusion of water molecules to generate contrast in MR images. It ...
(DTI) shows decreased fractional anisotropy, reflecting white matter damage. These imaging markers are highly consistent with
histopathological Histopathology (compound of three Greek language, Greek words: 'tissue', 'suffering', and ''-logy, -logia'' 'study of') is the light microscope, microscopic examination of Tissue (biology), tissue in order to study the manifestations of dis ...
features, enabling radiological-histopathological correlation and reducing the need for invasive biopsy in most cases. CSF analysis in Baló's concentric sclerosis typically shows either normal findings or mild mononuclear pleocytosis, but differs from classical multiple sclerosis in that CSF-restricted oligoclonal bands are present only in a minority of cases. Pattern III lesions, including Baló's concentric sclerosis, also tend to test negative for the MRZ reaction, which detects
intrathecal Intrathecal administration is a route of administration for drugs via an injection into the spinal canal, or into the subarachnoid space (sin. ''intrathecal space'') so that it reaches the cerebrospinal fluid (CSF). It is useful in several applic ...
responses to
measles Measles (probably from Middle Dutch or Middle High German ''masel(e)'', meaning "blemish, blood blister") is a highly contagious, Vaccine-preventable diseases, vaccine-preventable infectious disease caused by Measles morbillivirus, measles v ...
,
rubella Rubella, also known as German measles or three-day measles, is an infection caused by the rubella virus. This disease is often mild, with half of people not realizing that they are infected. A rash may start around two weeks after exposure and ...
, and
varicella zoster virus Varicella zoster virus (VZV), also known as human herpesvirus 3 (HHV-3, HHV3), is one of nine known herpes viruses that can infect humans. It causes chickenpox (varicella) commonly affecting children and young adults, and shingles (herpes zos ...
, further distinguishing them from standard multiple sclerosis. In pediatric populations, Baló's concentric sclerosis has been observed to have a more variable clinical course, with some children exhibiting favorable outcomes and lesion resolution on imaging, while other experience severe presentations similar to adult forms. Baló lesions have been identified in children presenting with
acute disseminated encephalomyelitis Acute disseminated encephalomyelitis (ADEM), or acute demyelinating encephalomyelitis, is a rare autoimmune disease marked by a sudden, widespread attack of inflammation in the brain and spinal cord. As well as causing the brain and spinal co ...
(ADEM)-like features, reflecting the overlap of concentric lesion morphology across multiple demyelinating syndromes.


Treatment

Acute Management High dose intravenous corticosteroids, such as
methylprednisolone Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol) is a synthetic glucocorticoid, primarily prescribed for its anti-inflammatory and immunosuppressive effects. It is either used at low doses for chronic illnesses or used at high doses durin ...
, are commonly administered as first-line therapy for acute Baló's concentric sclerosis episodes to reduce inflammation and stabilize the blood-brain barrier. However, responses to corticosteroids can be variable, with some patients exhibiting limited improvement. Immunosuppressive and Disease-Modifying Therapies Given the overlap of Baló's concentric sclerosis with other demyelinating disorders, various immunosuppressive agents have been explored:
Cyclophosphamide Cyclophosphamide (CP), also known as cytophosphane among other names, is a medication used as chemotherapy and to suppress the immune system. As chemotherapy it is used to treat lymphoma, multiple myeloma, leukemia, ovarian cancer, breast cancer ...
is an alkylating agent that suppresses the immune system, and has been used in aggressive or refractory cases of Baló's concentric sclerosis, sometimes in combination with other therapies.
Rituximab Rituximab, sold under the brand name Rituxan among others, is a monoclonal antibody medication used to treat certain autoimmune diseases and types of cancer. It is used for non-Hodgkin lymphoma, chronic lymphocytic leukemia (in children and ad ...
is a
monoclonal antibody A monoclonal antibody (mAb, more rarely called moAb) is an antibody produced from a cell lineage made by cloning a unique white blood cell. All subsequent antibodies derived this way trace back to a unique parent cell. Monoclonal antibodie ...
targeting
CD20 B-lymphocyte antigen CD20 or CD20 is B lymphocyte cell-surface molecule. It is a 33-37 kDa non-glycosylated protein. CD20 is expressed on the surface of B-cells from the pre-B phase, the expression is lost in terminally differentiated plasm ...
-positive B cells (B cell markers) and has shown to benefit patients with features suggestive of antibody-mediated pathology. Another monoclonal antibody called
Alemtuzumab Alemtuzumab, sold under the brand names Campath and Lemtrada among others, is a medication used to treat chronic lymphocytic leukemia and multiple sclerosis. In chronic lymphocytic leukemia, it has been used as both a first line and second lin ...
targets
CD52 CAMPATH-1 antigen, also known as cluster of differentiation 52 (CD52), is a glycoprotein that in humans is encoded by the ''CD52'' gene. CD52 is present on the surface of mature lymphocytes, but not on the stem cells from which these lymphocytes ...
and depletes a broad range of immune cells. The use of Alemtuzumab in Baló's concentric sclerosis has been reported in a case study indicating potential benefits, although some outcomes can vary.
Ocrelizumab Ocrelizumab, sold under the brand name Ocrevus, is a medication used for the treatment of multiple sclerosis. It is a humanized anti-CD20 monoclonal antibody. It targets CD20 marker on B lymphocytes and is an immunosuppressive drug. Ocrelizu ...
is similar to Rituximad in that it targets CD20-positive B cells and has demonstrated effectiveness in reducing lesion size and improving neurological function in cases of Baló's concentric sclerosis. Supportive Care and Monitoring Regular monitoring through MRI is essential to assess lesion progression or resolution. Given the potential for spontaneous remission in some cases, treatment plans should be individualized, balancing the risks and benefits of aggressive
immunosuppression Immunosuppression is a reduction of the activation or efficacy of the immune system. Some portions of the immune system itself have immunosuppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse react ...
. Multidisciplinary care, including physical and
occupational therapy Occupational therapy (OT), also known as ergotherapy, is a healthcare profession. Ergotherapy is derived from the Greek wiktionary:ergon, ergon which is allied to work, to act and to be active. Occupational therapy is based on the assumption t ...
, may aid in functional recovery and improve quality of life.


Epidemiology

Baló's concentric sclerosis most commonly affects individuals between 20–40 years of age, although pediatric and elderly cases have been documented. While multiple sclerosis is generally more prevalent in females, Baló's concentric sclerosis seems to show a slight male predominance, distinguishing from typical multiple sclerosis epidemiological patterns. In addition to its occurrence as an isolated demyelinating syndrome, Baló's lesions have also been reported in association with tumefactive inflammatory leukoencephalopathy, where they may present as part of a larger tumefactive plaques. Potential associations between Baló's concentric sclerosis and systemic autoimmune diseases, including
psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small localized patches to complete b ...
and
autoimmune thyroiditis In immunology, autoimmunity is the system of immune responses of an organism against its own healthy cells, tissues and other normal body constituents. Any disease resulting from this type of immune response is termed an "autoimmune disease". ...
, have also been reported, although the significance of these findings remain unclear and warrants further investigation. Pattern III (Baló-like) Demyelinating Spectrum Baló-like lesions were classified as MS lesion pattern III in the MS spectrum. They have been reported alone, but also associated to standard multiple sclerosis,
neuromyelitis optica Neuromyelitis optica spectrum disorders (NMOSD) are a spectrum of autoimmune diseases characterized by acute inflammation of the optic nerve (optic neuritis, ON) and the spinal cord ( myelitis).Banerjee S, Butcher R. Rituximab for the Treatment o ...
,
CADASIL CADASIL or CADASIL syndrome, involving cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, is the most common form of hereditary stroke disorder and is thought to be caused by mutations of the '' NOTCH3'' gen ...
and
progressive multifocal leukoencephalopathy Progressive multifocal leukoencephalopathy (PML) is a rare and often fatal viral disease characterized by progressive damage (''-pathy'') or inflammation of the white matter (''leuko-'') of the brain (''-encephalo-'') at multiple locations (''mu ...
. There is an overlap between what is considered Baló concentric sclerosis and some atypical cases of multiple sclerosis. A special subtype of multiple sclerosis presents Baló-like lesions (pattern III lesions) creating an intersection between these two conditions. Some patients with Baló concentric sclerosis present oligoclonal bands while others do not. It has been proposed that Baló concentric sclerosis lesions may not denote a single disease, but a final pathway of various demyelinating diseases, reflecting the presence of intralesional hypoxia as recently proposed. Recently it has been reported that pattern III lesions are responsive to
mitoxantrone Mitoxantrone (INN, BAN, USAN; also known as Mitozantrone in Australia; trade name Novantrone) is an anthracenedione antineoplastic agent. Uses Mitoxantrone is used to treat certain types of cancer, mostly acute myeloid leukemia. It improves th ...
. On the other hand, this pattern is the less responsive to
plasmapheresis Plasmapheresis (from the Greek language, Greek πλάσμα, ''plasma'', something molded, and ἀφαίρεσις ''aphairesis'', taking away) is the removal, treatment, and return or exchange of blood plasma or components thereof from and to the ...
. Pattern III lesions can be diagnosed without a biopsy because these patients show a high reactivity to AQP1 (without antibody) and varicella zoster virus (VZV).


Etiology of Lesions

The pathogenesis of Baló concentric sclerosis and pattern III multiple sclerosis lesions has been a subject of ongoing debate. Early hypotheses proposed that pattern III lesions represented an initial stage in the development of classical multiple sclerosis plaques; however, subsequent pathological and immunological studies have cast doubt on this view, suggesting that these lesions may instead reflect a distinct pathogenic process. Pattern III lesions are characterized by features of distal oligodendrogliopathy and selective oligodendrocyte apoptosis, which differ from the more common pattern I and pattern II multiple sclerosis lesions, where perivascular T-cell infiltration and antibody and complement deposition dominate. This distinct pathology has led to consideration of alternative environmental or infectious triggers as contributing factors to the development of these lesions. One such proposed trigger involves the bacterium
Clostridium perfringens ''Clostridium perfringens'' (formerly known as ''C. welchii'', or ''Bacillus welchii'') is a Gram-positive, bacillus (rod-shaped), anaerobic, spore-forming pathogenic bacterium of the genus '' Clostridium''. ''C. perfringens'' is ever-present ...
. A study by Rumah et al. (2013) identified type B strains of C. perfringens, known for producing the epsilon toxin, in a patient at the first clinical presentation of multiple sclerosis, suggesting a potential environmental association with lesion initiation. This hypothesis is supported by findings showing that individuals with multiple sclerosis exhibit significantly higher immune reactivity against epsilon toxin compared to healthy controls, indicating prior exposure or immune sensitization to this microbial product. Further complicating the etiological understanding of Baló concentric sclerosis is evidence of astrocytic involvement with lesion formation. Studies have demonstrated loss of both auqaporin-1 (AQP1) and
aquaporin-4 Aquaporin-4, also known as AQP-4, is a water channel protein encoded by the ''AQP4'' gene in humans. AQP-4 belongs to the aquaporin family of integral membrane proteins that conduct water through the cell membrane. A limited number of aquaporins ...
(AQP4) channels in demyelinated regions of Baló concentric sclerosis patients, even in the absence of detectable AQP4 autoantibodies. This pattern of astrocyte damage differs from that seen in classical neuromyelitis optica spectrum disorder (NMOSD), where AQP4-IgG antibodies are typically present, yet suggests a possible overlap in the astrocytopathic mechanisms contributing to lesion development. Patients have also shown heightened immune reactivity to AQP1 peptides, implying that astrocytic injury may be mediated by mechanisms other than antibody binding, possibly involving direct T-cell cytotoxicity or toxin-mediated astrocytic dysfunction.


See also

*
Multiple sclerosis Multiple sclerosis (MS) is an autoimmune disease resulting in damage to myelinthe insulating covers of nerve cellsin the brain and spinal cord. As a demyelinating disease, MS disrupts the nervous system's ability to Action potential, transmit ...
* The Lesion Project *
Tumefactive multiple sclerosis Tumefactive multiple sclerosis is a condition in which the central nervous system of a person has multiple demyelinating lesions with atypical characteristics for those of standard multiple sclerosis (MS). It is called tumefactive as the lesions ...


References


External links

{{DEFAULTSORT:Balo Concentric Sclerosis Demyelinating diseases of CNS Autoimmune diseases Rare diseases