Balo’s concentric sclerosis: is it pathogenic subtype of Multiple Sclerosis or distinct disorder?

Cover Page

Cite item

Full Text


Balo’s concentric sclerosis is a monophase demyelinating disease characterized by alternating rings of demyelinated and myelinated axons, and it is most frequently diagnosed by magnetic resonance imaging. At the present time Balo’s sclerosis is discussed in case of MRI detection of two or more concentric areas of demyelination, one or more ring of that is enhanced by the contrast. For 100-year period of the study there are 4 main theory of pathogenesis of Balo’s sclerosis: theory of concentric demyelination, theory of distal oligodendrocytopathy, colloid theory and theory of astrocytopathy. None of the theories includes all details of the disease. One of the details is concentric lesions in monophasic Balo sclerosis and in Balo-like syndromes in chronic demyelinating disorders. In case of Balo’s sclerosis and Balo-like syndromes probability of resistant to immunosuppressiv therapy is very high. So glucocorticosteroid therapy must be initiated right after concentric demyelination determination on MRI. In case of ineffectiveness of glucocorticosteroid therapy plasmapheresis and cytostatic therapy could be applied.


About the authors

A. A. Vorobyeva

Research Center of Neurology

Author for correspondence.
Russian Federation, Moscow

Rodion N. Konovalov

Research Center of Neurology

ORCID iD: 0000-0001-5539-245X

Cand. Sci. (Med.), senior researcher, Neuroradiology department

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80

Marina V. Krotenkova

Research Center of Neurology

ORCID iD: 0000-0003-3820-4554

D. Sci. (Med.), Head, Neuroradiology department

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80

A. V. Peresedova

Research Center of Neurology

Russian Federation, Moscow

Maria N. Zakharova

Research Center of Neurology

Russian Federation, Moscow


  1. Balo J. Leukoencephalitis periaxialis concentrica. Arch Neurol Psychiatry. 1927; 28: 108–124.
  2. Barun B., Adamec I., Habek M. Balo’s Concentric Sclerosis in Multiple Sclerosis Intern Med. 2012; 51: 2065–2066.
  3. Casraigne P., Escourolle R., Chain F. et al. Sclkrose concentrique de Balo. Rev Neurol (Paris). 1984; 140: 479–487.
  4. Chu M.L., Zamuco J., Perez M.C. et al. Balo’s concentric sclerosis – a case report. Folia Psychiatr Neurol Jpn. 1982; 36: 417–420.
  5. Graber J.J., Kister I., Geyer H. et al. Neuromyelitis optica and concentric rings of Baló in the brainstem. Arch Neurol. 2009; 66 (2): 274–275.
  6. Hardy T.A., Miller D.H. Balo’s concentric sclerosis. Lancet Neurol. 2014; 13 (7): 740–746.
  7. Khonsari R.H., Calvez V. The Origins of Concentric Demyelination: Self-Organization in the Human Brain Human Brain Self-Organization PLoS ONE. 2007; 2(1): 150-155.
  8. Lucchinetti C., Bruck W., Parisi J., M.D. et al. Heterogeneity of Multiple Sclerosis Lesions: Implications for the Pathogenesis of Demyelination Annals of Neurology. 2000; 47: 707–717.
  9. Matsuoka T., Suzuki S.O., Iwaki T. et al. Aquaporin-4 astrocytopathy in Balo’s disease Acta Neuropathol. 2010; 120 (5): 651–607.
  10. Moore G.R.W., Neumann P.E., Suzuki K. et al. Balo’s concentric sclerosis: new observations on lesion development Ann Neurol. 1985;17: 604–611.
  11. Murburg O. Die so-genannte ‘aukute multiple sklerose’ (Encephalomyelitis periaxialis scleroticans). Jahrb Psychiatr. 1906; 28: 213–312.
  12. Ordinario A., Tabira T. Fifteen autopsied cases of concentric sclerosis (Balo) seen in the Philippines. Int Center Med Res Ann. 1987;139–148.
  13. Rao M-L., Lu D-S., Lin S-H. et al. Clinical and pathological studies on ten cases of Bal6’s concentric sclerosis. Chin J Neurol Psychiatr.1983; 16: 299–302.
  14. Spiegel M., Krueger H., Hofmann E., Kappos L. MRI study of Ba16’s concentric sclerosis before and after immunosuppressive therapy. J Neurol. 1989; 236: 487–488.
  15. Stadelmann C., Brück W. Lessons from the neuropathology of atypical forms of multiple sclerosis Neurol Sci. 2004; 25: 319–322.

Supplementary files

Supplementary Files

Copyright (c) 2015 Vorobyeva A.A., Konovalov R.N., Krotenkova M.V., Peresedova A.V., Zakharova M.N.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77-83204 от 12.05.2022.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies