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Balo’s Disease

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Overview

Balo’s disease is a rare demyelinating disorder of the central nervous system (CNS) in which the myelin (the fatty substance covering nerve fibers) is damaged. Balo’s disease shares features with other demyelinating diseases and is generally regarded as a rare variant of multiple sclerosis (MS).
Balo’s disease is also known as Balo disease, encephalitis periaxialis concentrica, leukoencephalitis periaxialis concentrica and concentric sclerosis. The term "concentric sclerosis" comes from a pattern of concentric (circular) areas of damaged myelin alternating with areas of relatively undamaged myelin in various parts of the brain and spinal cord. This pattern can be seen on magnetic resonance imaging (MRI).
Attacks from Balo's disease can proceed rapidly over weeks or months, without remission (a rapidly progressive course); a relapsing course (periods of symptoms followed by improvement or disappearance of symptoms) can also occur, or a person may experience a single attack (monophasic course).

What causes Balo’s disease?

The cause of Balo’s disease is not known, however, some studies indicate that autoimmune factors may play a role in its development. Autoimmune disorders are caused when the body's natural defenses against "foreign" or invading organisms begin to attack healthy tissue for unknown reasons resulting in inflammation (swelling).

The cause of the recovery seen in some patients that have or have not received treatment is also not known.

Who gets Balo’s disease, and when?

Balo's disease appears to be most common in people of east Asian origin, with the highest prevalence in southern Han Chinese, Taiwanese, and Filipinos. It appears to likely affect females more frequently than males and usually appears in adulthood but childhood cases have been reported.
 

How is Balo's disease different from MS?

Balo's disease is generally considered a variant of MS because so many of the symptoms are similar to those seen in MS, and because brain tissue from MS and Balo’s lesions viewed under the microscope have many similar features. Furthermore, lesions consistent with Balo’s disease have been described to occur during the clinical course of otherwise typical relapsing-remitting MS, and some patients have gone on to develop typical MS after initially having Balo’s lesions. However, the unusual, concentric ring pattern seen on MRI images and in tissue specimens in Balo’s, is not typically seen in MS.
 
Reviewed by Elias Sotirchos, MD November 2019

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