Balo Concentric Sclerosis in Children A Case Series

Balo concentric sclerosis is a unique and rare phenomenon in demyelinating disease. Typically thought of as a subtype of multiple sclerosis, Balo concentric sclerosis is characterized pathologically by striking rings of demyelination alternating with areas of preserved myelination. Its exact prevalence in adult and especially pediatric populations is unknown. Although traditionally considered to be an acute and fatal disease of adults, there are a handful of reports of Balo concentric sclerosis cases in pediatric patients. Here we report Balo concentric sclerosis-like demyelinating disease in 3 female pediatric patients, representing 2.2% of a cohort of 134 pediatric patients with demyelinating diseases who have been seen in our center since 2005. The relatively high prevalence of Balo concentric sclerosis-like cases in our pediatric demyelinating diseases center, none of which have been fatal, supports the premise that the developing immune and central nervous systems may manifest and respond to demyelinating disease differently from adults.