According to abbreviationfinder, BS stands for Baló’s disease. Baló’s disease is a neurological disorder also known as concentric sclerosis and is the acute variant of multiple sclerosis. Damage to the white matter, which forms a clearly visible ring pattern through demyelination, is the main feature of Baló disease. Treatment is usually drug-based.
What is Baló disease?
An imaging procedure is required to establish the diagnosis; Due to its high spatial resolution, magnetic resonance imaging (MRI) is the most suitable.
Spiral demyelination of the white matter in the central nervous system (CNS) is the main feature of Baló disease. The white matter is the myelinated (and therefore electrically insulated) fibers of the nerve cells. In 1928, the Hungarian József Baló first described the disease in deceased patients.
With the help of magnetic resonance imaging (MRI), doctors can now visualize the characteristic clinical pattern in the cerebrum: the neurodegenerative disease leaves behind concentric circles in the white matter that resemble the annual rings of a tree or a sliced onion.
They arise because the demyelination does not affect the myelin cells evenly, but causes alternately stronger and weaker atrophy. Baró’s disease is a variant of multiple sclerosis, which is also characterized by demyelination of the white matter and often occurs in episodes. Synonyms for the disease are concentric sclerosis Baló, encephalitis periaxilis concentrica and Baló’s disease.
Causes
Specific causes of concentric sclerosis have not yet been adequately researched; they are due to more than one influence and are therefore multifactorial. Baló’s disease is the acute variant of multiple sclerosis and may therefore be due to similar risk factors. These factors include genetic predisposition and environmental factors.
In the specialist literature, scientists discuss, among other things, the influence of nutrition such as vitamin D deficiency and infections with the Epstein-Barr virus. According to current knowledge, demyelination is caused by inflammation in the CNS, which in turn is due to an autoimmune reaction. In multiple sclerosis, the chronic form, several foci of inflammation appear.
Researchers explain the concentric circles by a substance that is produced outside the brain and migrates through the blood-brain barrier into the tissue, spreading rhythmically by means of diffusion. This type of diffusion is inherent to the tissue and is not specific to this substance, which as it spreads damages the myelin, leaving concentric circles in the tissue. Depending on which areas of the nervous system are damaged, the disease can manifest itself in different symptoms.
Symptoms, Ailments & Signs
The externally visible and noticeable symptoms of Baló’s disease can vary greatly depending on the patient. Depression, ataxia, cognitive impairments, movement disorders, spasticity, paralysis and pain without a recognizable physical cause are complaints that can possibly occur with multiple and concentric sclerosis.
Sensitivity disorders, in which the physical sensation of certain stimuli is limited or absent, are also conceivable. Medicine differentiates between four basic types of sensory disorders, each of which can manifest itself in all sensory qualities: reduced sensitivity (hypaesthesia), increased sensitivity (hyperesthesia), misperception of stimuli (dysesthesia; for example, pain from light touch) and perception of stimuli that are not actually present (paresthesia ; for example, tingling in the fingers).
These symptoms can occur in a variety of neurological conditions and include sensitivity to temperature, touch, movement, position, vibration, force, and pain.
Diagnosis & course of disease
An imaging procedure is required to establish the diagnosis; Due to its high spatial resolution, magnetic resonance imaging (MRI) is the most suitable. Baló disease is confirmed when MRI shows the typical concentric pattern in the white matter of the cerebrum. In addition, the MRI image shows demyelination in almost half of the patients, which indicates multiple sclerosis.
Young adults are particularly well represented among those affected. Doctors cannot yet say with certainty which course is actually typical for Baló disease: Early detection was not possible for a long time, until 2004 many findings about the clinical picture were based on examinations that took place after the death of the affected patients. Reliable predictions are also difficult to make at the individual level. However, Baló disease is likely to progress through a single, severe phase.
Complications
In most cases, this disease causes severe paralysis that can affect the entire body. As a rule, paralysis leads in any case to severe restrictions in movement and to disturbances in sensitivity, which leads to a significant reduction in the quality of life. In some cases, the person concerned is dependent on a wheelchair or on the help of other people in everyday life. Spasms can also occur.
It is not uncommon for mental and motor development disorders to occur in the course of development. This can lead to teasing and bullying, especially among children. Stimuli cannot usually be properly perceived either, and those affected are highly sensitive to temperatures. Severe pain is not uncommon. Parents can also suffer from mental illness or depression as a result of the symptoms.
The treatment of this disease is carried out with the help of drugs. There are no further complications. However, not all complaints can be restricted. This may result in a reduced life expectancy. The affected person is dependent on various therapies.
When should you go to the doctor?
If movement disorders, paralysis and other signs of concentric sclerosis Baló are noticed, a doctor should be consulted. The condition must be treated before serious complications develop. If health problems have already occurred, a doctor must be consulted immediately. The same applies if the physical symptoms are accompanied by psychological complaints, such as depression or personality changes. If severe paralysis sets in, medical advice is also required.
Parents who notice mental and motor development disorders in their child are best advised to consult a pediatrician. He can diagnose Baló’s disease and, if necessary, initiate treatment immediately. This is necessary at the latest when the child complains of pain. Since the disease can be a great psychological burden for the child and parents, a therapist must be consulted in addition to medical treatment. Other contacts are internists and orthopaedists. A nutritionist can work out an individual diet in consultation with the parents and thereby alleviate the symptoms.
Treatment & Therapy
Doctors often use glucocorticoids in their practice to treat Baló disease, but these do not bring about an improvement in all cases. The steroid hormone also occurs naturally in the human body; the adrenal cortex produces it to break down fats and proteins and to synthesize carbohydrates. In high doses, such as those found in medicines, they inhibit the formation of proteins.
These include the immune system’s antibodies, which mistakenly trigger an inflammatory response in Baló’s disease and multiple sclerosis. Mitoxantrone is also a possible active ingredient, which is also used in multiple sclerosis; so far, however, there are only isolated case reports on its effectiveness in concentric sclerosis.
The same applies to other forms of treatment such as the exchange of blood plasma (plasmapheresis). The attending physician must assess the possibilities and risks of different options individually in each case.
Outlook & Forecast
Baló concentric sclerosis is one of the variants of multiple sclerosis, a so-called borderline form. It affects the central nervous system and, unlike MS, usually does not occur in episodes. In concentric sclerosis Baló, typical concentric lesions form in the demyelinated tissue.
The prognosis of Baló concentric sclerosis is slightly better than that of multiple sclerosis. In some cases, spontaneous remission occurs. In others, an asymptomatic case may take an individual course. In many monophasic courses, the symptoms of the acute inflammatory demyelinating disease can be improved.
The disease of the CNS, also known as encephalitis periaxialis concentrica, occurs primarily in young adults. The symptoms depend on which region of the brain is affected. While this disease was always fatal in the past and could only be diagnosed post mortem, the prospects are better today. Treatment can be initiated with gluco-corticoids, immunosuppressants, or plasmapheresis.
If there are lesions in concentric sclerosis Baló as in MS, the course of the disease can also be similar and relapsing. This is the case for about a third to half of those affected. In this case, MS preparations are also administered for prophylaxis and prevention of flare-ups. In a monophasic course of the disease, the prognosis is generally better.
Prevention
Since the causes of Baló disease are still largely unknown and the development is based on the interaction of many complex factors, targeted and reliable prevention is not possible.
Aftercare
In most cases, patients with Baló sclerosis only have a few direct follow-up measures available. Here, a diagnosis of the disease and subsequent treatment must take place very early on in order to prevent further complications. If the disease is not treated properly by a doctor, there are usually significant limitations in movement as it progresses.
These can have a very negative impact on the patient’s quality of life. Patients with this disease are usually dependent on taking various medications. You should always pay attention to the correct dosage and continue to take it regularly in order to permanently relieve the symptoms.
Many patients are dependent on the support and help of other people in their everyday lives, whereby the help and care of their own family in particular can have a very positive effect on the further course of this disease. Intensive and loving conversations with the person concerned are also very important here, so that depression and other mental upsets can be prevented. It cannot be universally predicted whether Baló sclerosis will lead to a reduced life expectancy for those affected.
You can do that yourself
Patients with concentric sclerosis Baló usually suffer from severe limitations in everyday activities and quality of life. The reason for this is, on the one hand, the motor disorders and movement restrictions, with long-term physiotherapy making a positive contribution to the patient’s body awareness. The patients also carry out certain physiotherapy exercises at home and thus support the maintenance of the muscles.
If paralysis sets in or mobility limitations are too great, many patients use a wheelchair. It makes sense to adapt the apartment of the person concerned to the use of a wheelchair. In some cases, moving to a barrier-free environment is necessary in order to enable patients to be more independent. In addition, care facilities come into question in which the patients also benefit from the social aspect through contact with other sick people.
Proper intake of the prescribed medication is important for the patient’s quality of life. However, the life expectancy of those affected is reduced even with adequate therapy. Along with the pain and other discomfort, some patients develop depression. Psychotherapeutic treatment helps the affected person to alleviate their mental suffering.
