The detection of serum anti-brain antibodies in a cohort of patients with tumefactive demyelinating lesions of the CNS.

Abstract

Background:

A tumefactive demyelinating lesion (TDL) is defined as being at least 2cm in diameter, whilst conventional multiple sclerosis (CMS) lesions usually have a diameter less than 9 mm. There are no studies assessing the presence of antibodies in tumefactive MS (TMS), rare variants of MS, or monophasic presentations of TDLs not otherwise specified (TDL NOS).

Hypothesis:

Patients with TDLs have serum anti-brain antibodies that are more numerous and/or unique in comparison to CMS.

Methods:

Patients attending a tertiary referral centre were invited to participate in this project on the detection of anti-brain antibodies in patients with TDLs. A case series study of patients with similar very large demyelinating lesions was performed. The serum of consenting patients was analysed for the presence of anti-brain antibodies by IIF.

Results:

Fifty-nine patients with a TDL were compared to 58 patients with CMS. The term giant demyelinating lesion (GDL) was proposed for TDLs larger than 4 cm in diameter. A unique clinical phenotype of 4 patients with a GDL was identified in the case series. The frequency of TDL occurrence in MS was higher than reported. More than 50% of patients had high-intensity serum anti-brain antibodies identified, with no statistically significant difference between cases and controls. There were no definite unique antibodies in the TDL group. Patients who have a monophasic GDL or TDL, as well as those with relapsing remitting MS (RRMS) and a TDL, had common serum anti-brain antibodies that were more frequent in comparison to CMS. The results showed that some primary progressive MS (PPMS) cases may have similar antibody involvement. Patients with secondary progressive MS (SPMS) had significantly less high intensity serum anti-brain antibodies compared to RRMS and PPMS.

Conclusion:

TDLs may not have novel autoantibodies, or greater autoantibody involvement in comparison to other demyelinating diseases such as MS. Additional studies are required.