Article

Demyelinating diseases presenting with a tumefactive demyelinating
lesion (TDL) raise questions about classification, diagnosis, prognosis, and
treatment. Their long-term course is not well described in literature.
PATIENTS/METHODS: In a retrospective study, we describe the main characteristics
of 29 patients with TDLs. In a case control study, we compared two cohorts of
multiple sclerosis (MS) patients: 24 MS patients with TDL versus a reference
cohort of patients with relapsing remitting MS. We compared the extended
disability status score (EDSS) concerning the first demyelinating event (DE) with
TDL, EDSS score at the end of follow-up and treatment intake. The objective was
to discuss the prognosis and the management of TDL. RESULTS: In our study, the
prognosis was better for patients with non-prevalent TDL (first DE without TDL)
compared with patients with prevalent TDL (first DE with TDL) and was not
different compared with the MS reference cohort. At the end of follow-up, there
was no significant difference between patients treated with immunosuppressors
after a first DE with TDL and patients with classical MS. The EDSS at the end of
follow-up was statistically more severe for untreated patients after a first DE
with TDL than for classical MS patients (P=0.0047). DISCUSSION: The prognosis of
patients with TDL is difficult to assess because of its multifactorial nature
(underlying disease and treatment impact). In our cohort, outcome of MS patients
whose first severe DE involved a TDL was better when they received an early
immunosuppressive treatment.
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Langue : FRANCAIS