An Overview of Balo Disease

A Rare Type of Progressive Multiple Sclerosis

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Balo disease is a rare and progressive type of multiple sclerosis (MS). MS is known for attacking and damaging tissues in the brain and spinal cord, causing areas of inflamed tissues. Balo disease can damage the same tissues, but it also causes large lesions on the brain and spinal cord. The lesions associated with MS look like small spots or blotches, whereas the ones with Balo look like bull’s eye marks, which is why it is sometimes called Balo concentric sclerosis. It is also called Balo's disease, encephalitis periaxialis concentrica, and leukoencephalitis periaxialis concentric.

Balo’ usually begins in adulthood, but it has been known to affect children. Balo disease can rapidly worsen and advance. Some people with Balo never get relief from symptoms and their disease worsens with time, but this is not the case for every person with the condition.

Here is what you need to know about Balo disease including symptoms, causes, diagnosis, treatment, and prognosis.

Symptoms

The symptoms of Balo disease are similar to the symptoms of MS. These may include:

  • Headaches
  • Seizures
  • Muscle pain, spasms, and weakness
  • Paralysis over time
  • Aphasia—problems with speaking
  • Trouble with concentration or understanding others        
  • Behavior changes

Balo presents in three different ways—acute and self-limiting, relapsing-remitting variant, and rapidly progressive primary disease. Presentation and seriousness depend on the location of lesions in the brain. Sometimes, Balo lesions mimic symptoms of intracerebral mass (existing within the cerebrum of the brain), causing cognitive problems, seizures, behavioral changes, and headaches. 

Most cases of Balo disease are distinguished by a steady onset of symptoms. Early symptoms of Balo are also found in MS, including muscle spasms and paralysis. Other neurological symptoms will start to develop based on the parts of the brain that are affected. Some people with the condition may go on to develop intellectual impairment or physiological abnormalities (conditions which cause the organs of the body to malfunction, i.e. asthma, glaucoma, diabetes).

Balo disease can occur on its own, but it may also co-exist with MS. One 2015 report in the journal Case Reports in Neurology reported on the case of a 25-year-old woman who presented with stroke-like symptoms. She also had MS-typical brain lesions. Based on these findings, the doctors confirmed the woman had both Balo disease and MS. They also noted in instances where a patient had both conditions, Balo disease wasn’t necessarily severe and often harmless.

Prevalence

Because of its rarity, there are few statistics or prevalence studies on Balo disease. Much of the research is specific to individual cases of the condition including symptoms and disease management.

One 2012 report in the International Journal of Applied and Basic Medical Research reports many of the cases of Balo disease are not identified until after a person has died. These instances are likely to have been in people who did not experience symptoms or a progressing disease while alive.

Causes

Doctors and researchers don’t know what triggers Balo disease. Most think it is an autoimmune disease. Autoimmune conditions occur when the immune system mistakenly attacks healthy tissue, resulting in inflammation (swelling) throughout the body.

Balo disease often affects young adults, with an average age of onset of age 34. Much like MS, the condition is more common in women. There may be a genetic component related to Balo’s disease as the condition is more prevalent in people with Southeast Asian descent—Southern Han Chinese, Taiwanese, and Filipino populations.

One theory is that Balo’s is linked to infection, but no study has confirmed this. This theory is based on the idea that some of the symptoms of infection—including fever and severe headache—are the earliest symptoms of the condition. 

Diagnosis

A neurologist is in the best position to make a diagnosis of Balo disease. The physician will ask about medical history and symptoms. A physical exam will also be done to see how well a person moves and to look for muscle weakness. Your doctor will also want to determine if you are experiencing any memory or cognitive problems and how well you are speaking.

A magnetic resonance imaging (MRI) scan of the brain and spinal cord may be done to check for lesions. Blood tests can help to check for infection, and your doctor may take a sample of spinal fluid from the low back for testing to look for abnormalities.

An evoked potential (EP) test may also be done. This involves a technician placing small patches on the scalp connected by wires to a machine to measure brain activity. The technician will then listen, watch, and feel for certain brain activities using stimuli, including light patterns, clicks, or short electric bursts. 

Treatment

There is no cure for Balo disease and there are no medications that have been specifically designed for treating the condition. However, many of the same medications given to treat MS, including corticosteroids, can manage brain and spinal cord tissue swelling. Your doctor may also prescribe medications to help with pain and to manage muscle spasms and weakness.

One March 2011 report in The Journal of the American Osteopathic Association describes a case of Balo disease in a 30-year woman who was treated with high doses of steroids. The woman experienced a positive result with most of her neurological symptoms gone. The report’s authors also reported on MRI findings, that showed a reduced number of brain lesions shortly after the start of treatment and then months matter. The authors suggest high doses of steroids early on can benefit people with Balo disease.

Other treatments for Balo disease include muscle relaxants to treat painful muscle stiffness, weakness, and spasms, especially in the legs. If you are experiencing severe fatigue, your doctor may prescribe medications to reduce fatigue. Other medications can be prescribed for depression, pain, sleep problems, and bladder and bowel control issues, conditions often associated with both Balo disease and MS.

Your doctor may also recommend physical or occupational therapy. Physical therapy can teach you stretching and strengthening exercises to manage leg weakness and gait problems. Occupational therapy can teach you to use mobility and assistive devices to use when performing daily tasks.

Prognosis

Individual cases of the condition have been reported showing successful treatment responses and no relapses of symptoms. In fact, some of the newer research shows many Balo disease cases are harmless and self-limited with the potential for spontaneous remission. Remission in autoimmune diseases, MS, and Balo's, is a period where disease symptoms subside for a period of time.

The prognosis for Balo disease can be positive. At the 2016 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), the case of a 46-year-old woman with Balo’s disease was discussed. The woman was diagnosed with Balo disease ten years prior and was showing continuing radiological and clinical stability. In her ten-year course with the disease, the woman, who was having regular MRIs, experienced three relapses and was successfully treated with Rebif (interferon beta 1-a) , an anti-inflammatory medication for people with MS.

A Word From Verywell

Talk to your doctor if you are experiencing frequent headaches and muscle pain, spasms, and weakness, and don’t delay treatment if you experience a seizure, paralysis, problems with speaking, concentration or understanding others, or severe behavior changes. Balo’s disease can be treated successfully if diagnosed and treated early.

Balo disease can result in severe disability or death if left untreated. Most people fare well once they have treated with corticosteroids. The number of people with Balo disease who survive and experience remission is increasing. Further, there are a number of people who never experience symptoms and whose disease never progresses. 

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  2. National Organization of Rare Diseases. Balo disease.

  3. Purohit B, Ganewatte E, Schreiner B, et al. Balo's concentric sclerosis with acute presentation and co-existing multiple sclerosis-typical lesions on MRI. Case Rep Neurol. 2015;7(1):44–50. doi:10.1159/000380813

  4. Dwivedi AN, Srivastava V, Thukral A, et al. A rare case of Balo concentric sclerosis showing unusual clinical improvement and response with oral prednisolone. Int J Appl Basic Med Res. 2012 Jul;2(2):136-8. doi:10.4103/2229-516X.106358

  5. Lanciano NJ, Lyu DS, Hoegerl C. High-dose steroid treatment in a patient with Balò disease diagnosed by means of magnetic resonance imaging. J Am Osteopath Assoc. 2011;111(3):170-2

  6. Kazimirchik A. 2016 Annual Meeting of The Consortium of Multiple Sclerosis Centers (CMSC). Balo's concentric sclerosis: 10 years follow-up. June 2, 2019.

Additional Reading
  • National Multiple Sclerosis Society. Balo’s disease. Updated November 2019.