Multiple Sclerosis Worldwide Research Articles

Prevalence, Incidence, and Mortality of Multiple Sclerosis in Coimbra, Portugal

Multiple sclerosis (MS) is the most common chronic inflammatory, demyelinating, and neurodegenerative disease of the central nervous system in young adults, representing the leading cause of nontraumatic disability in this population. The rising prevalence of MS worldwide makes it critical to recognize the absolute number of patients with MS, demanding the execution of a sustainable healthcare policy. In Portugal, only six studies evaluating MS rates were published, disclosing a prevalence of 64 cases per 100,000 persons and an incidence of 3.1 cases per 100,000 persons/year, but the mortality rates have not been reported. Thus, this observational, cross-sectional study aimed to assess MS prevalence, incidence, and mortality in the city of Coimbra, a region in the center of Portugal. Patients who fulfilled McDonald’s Diagnosis Criteria (2017) for MS were recruited. Inclusion criteria were defined according to prevalence, incidence, and mortality studies. The baseline demographic and clinical characterization of the prevalence study population was performed. The MS prevalence rate in Coimbra was 143.45 cases per 100,000 inhabitants. Between 2018 and 2021, the cumulative incidence was 8.52 new cases per 100,000 persons/year. The mortality rate between 2018 and 2021 was 2.84 deaths per 100,000 inhabitants. MS prevalence and incidence in Coimbra are higher than reported in previous similar studies and comparable to Europe’s mean prevalence and incidence.

Comparison of Pharmacological Therapies in Relapse Rates in Patients With Relapsing-Remitting Multiple Sclerosis.

Multiple sclerosis (MS) is a chronic autoimmune neurological disorder that significantly impacts the central nervous system (CNS), which includes the brain and spinal cord. Approximately 2.8 million individuals are believed to be living with MS worldwide. The management of MS has evolved considerably over the years, offering a multitude of guidelines, diverse treatment options, and different approaches to signs and symptoms. The present systematic literature review serves as a comprehensive analysis of the current therapeutic options for MS. It provides a thorough literature review of Food and Drug Administration (FDA)-approved drugs comparing their various clinical end points while concurrently assessing their risk-benefit ratio. It also provides an extensive review of current guidelines and offers an in-depth examination of the different approaches to MS. Through this multifaceted approach, this paper facilitates easy access to available treatment options and aims to aid healthcare providers in decision-making as well as providing a foundation for future research aimed at enhancing treatment options for MS.

GAU U-Net for multiple sclerosis segmentation

Multiple sclerosis is an auto immune disease which affects the brain and nervous system. A total of 2.8 million people are estimated to live with Multiple sclerosis worldwide (35.9 per 100,000 population). The pooled incidence rate across 75 reporting countries is 2.1 per 100,000 persons per year, and the mean age of diagnosis is 32 years. Lesions resulting from the disease can be spotted in the patients MRI scans. In this paper a novel Deep learning architecture GAU-U-net is proposed. The model is inspired from the very famous U-Net architecture used for semantic segmentation and widely used in medical image segmentation. The proposed model consists of 3D U-Net after adding a new attention technique inspired by the Global Attention Upsample unit. By using GAU-unet architecture the Dice coefficient increased from 64% to 72% compared to using 3D-Unet.Also, when compared with Unet- attention network the dice coefficient increased from 69% to around 72% with a considerable incline in the number of model parameters in favor of our architecture, which uses 28 M parameters compared to Unet-attention which uses100M parameters.

БІОХІМІЧНІ ПОКАЗНИКИ КРОВІ У ХВОРИХ НА РОЗСІЯНИЙ СКЛЕРОЗ, ЯКІ ПЕРЕНЕСЛИ ІНФЕКЦІЮ SARS-CoV-2

B a c k g r o u n d. Currently, multiple sclerosis (MS) is an important medical and social problem. There are already more than 2.8 million people with MS worldwide, and due to the lack of effective methods of treatment and prevention, the number of patients is increasing constantly. Therefore, the search for new ways and approaches aimed towards stabilizing the patient's condition is a priority task of modern neurobiology. It is also important to identify triggers that can lead to accelerating the rate of disease progression. Since MS is an immune-mediated disorder, we hypothesized that concomitant diseases of infectious etiology, via the activation of an inflammatory reactions cascade, can lead to a worsening of the MS patient's condition. However, the final answer to the question of whether acute viral infections affect the condition of patients with MS has not been obtained yet. In the context of the epidemiological situation that has developed in recent years, due to the spread of the SARS-CoV-2 coronavirus infection, it is interesting to study the possible negative consequences of COVID-19 in people suffering from MS. The aim of the study was to analyze the general biochemical status of patients with MS who had or did not have a confirmed history of COVID-19. M e t h o d s. A total of 271 participants were enrolled in this study, including 97 MS patients and 30 healthy volunteers who matched for age and sex. Patients with MS were divided into two groups: group I (n= 56; 36 women and 20 men, average age: 41.3±5.5, disease duration: 4.4±1.5 years) – patients with MS who did not have confirmed history of COVID-19 and group II (n= 41; 27 women and 14 men, average age: 40.2±5.6, disease duration: 4.6±1.3 years) – patients with MS, who had a laboratory-verified diagnosis of COVID-19 in the past 4-7 months. Blood serum samples of patients and healthy donors were obtained from the University Clinic of O.O. Bogomolets National Medical University, Kyiv, Ukraine. All patients were diagnosed with MS according to the 2017 McDonald criteria. R e s u l t s. It was established that both groups of MS patients had similar changes in blood biochemical parameters compared to the healthy indicators: a decrease in creatinine and uric acid concentrations; decrease in the levels of particular lipid fractions, namely VLDL and TAG; decrease in the activities of AP and LDH; increase in C-reactive protein concentration. The only significant differences between groups I and II were noted due to multidirectional changes in serum ferritin concentration and an increase in the level of amylase activity in the blood serum of patients with MS in post- COVID period. C o n c l u s i o n s. The absence of statistically significant differences between the blood biochemical parameters in patients with MS who had or did not have confirmed history of COVID-19 indicates the absence of a relationship between SARS-CoV-2 infection and changes of particular studied parameters. Among the results obtained, the multidirectional changes in ferritin concentration in MS patients before and after COVID-19 could be of great interest to further research.

The Impact of Stopping Medications and Introducing a Whole Food Plant-Based Diet on Patients Living with Multiple Sclerosis - A Report of Two Cases.

More than 2 million people live with multiple sclerosis worldwide and the prevalence has been increasing over time. Patients living with multiple sclerosis often explore diet and lifestyle interventions as a means of managing their symptoms and reducing reliance on medication; yet, these approaches are rarely discussed with their physicians. Currently, there is a lack of evidence on when to stop disease-modifying therapies (DMT), and recent research showed no statistically significant difference in the time between relapses when comparing participants who stopped DMT to those who did not, especially over the age of 45. This case report presents 2 patients with multiple sclerosis who made an informed decision to stop their DMT medications and have been managing their condition with a whole food plant-based diet and a healthy lifestyle approach. Over the period of 5 to 6years since stopping the medications, each patient only had 1 multiple sclerosis flare-up to date. In the report, the focus is on the impact of diet on multiple sclerosis. It adds to currently available literature and encourages further research in the field of managing multiple sclerosis with lifestyle interventions.

Diroximel Fumarate as a Novel Oral Immunomodulating Therapy for Relapsing Forms of Multiple Sclerosis: A Review on the Emerging Data.

Multiple sclerosis (MS) is a chronic inflammatory, demyelinating and neurodegenerative disorder of the central nervous system. Disease-modifying drugs (DMDs) and subsequent adherence are crucial for preventing reversible episodes of neurological dysfunction and delayed onset of progressive accumulation of irreversible deficits. Yet, side effects may limit their usage in clinical practice. Gastrointestinal (GI) side effects are a significant limitation of the use of dimethyl fumarate (DMF), the most frequently prescribed oral DMD in MS worldwide. Diroximel fumarate (DRF) is a second-generation oral fumaric acid ester (FAE) that was developed as a formulation with better GI tolerability. The improved tolerability is assumed to be related to a lower synthesis of gut-irritating methanol. Other explanations for DRF's lower extent of GI irritation include a more modest off-target activity due to its chemical structure. The superior GI tolerability of DRF compared to DMF could be proven in clinical trials and lead to approval of DRF for the treatment of relapsing forms of MS/relapsing-remitting MS (United States Food and Drug Administration and European Medicines Agency, respectively). Here, we summarize the mode of action of oral FAE and compare the chemical and physiological characteristics of DMF and DRF. Moreover, we discuss the adverse effects of FAE and introduce the emerging preclinical and trial data leading to the approval of DRF in MS. This article additionally reviews our current understanding of coronavirus disease 2019 (COVID-19) and the efficacy of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination in people treated with FAE.

Towards a global view of multiple sclerosis genetics.

Multiple sclerosis (MS) is a neuroimmunological disorder of the CNS with a strong heritable component. The genetic architecture of MS susceptibility is well understood in populations of European ancestry. However, the extent to which this architecture explains MS susceptibility in populations of non-European ancestry remains unclear. In this Perspective article, we outline the scientific arguments for studying MS genetics in ancestrally diverse populations. We argue that this approach is likely to yield insights that could benefit individuals with MS from all ancestral groups. We explore the logistical and theoretical challenges that have held back this field to date and conclude that, despite these challenges, inclusion of participants of non-European ancestry in MS genetics studies will ultimately be of value to all patients with MS worldwide.

SARS-CoV-2 and Multiple Sclerosis: Potential for Disease Exacerbation.

While the respiratory tract is the primary route of entry for SARS-CoV-2, evidence shows that the virus also impacts the central nervous system. Intriguingly, case reports have documented SARS-CoV-2 patients presenting with demyelinating lesions in the brain, spinal cord, and optic nerve, suggesting possible implications in neuroimmune disorders such as multiple sclerosis (MS) and other related neuroimmune disorders. However, the cellular mechanisms underpinning these observations remain poorly defined. The goal of this paper was to review the literature to date regarding possible links between SARS-CoV-2 infection and neuroimmune demyelinating diseases such as MS and its related disorders, with the aim of positing a hypothesis for disease exacerbation. The literature suggests that SARS-CoV, SARS-CoV-2, and orthologous murine coronaviruses invade the CNS via the olfactory bulb, spreading to connected structures via retrograde transport. We hypothesize that a glial inflammatory response may contribute to damaged oligodendrocytes and blood brain barrier (BBB) breakdown, allowing a second route for CNS invasion and lymphocyte infiltration. Potential for molecular mimicry and the stimulation of autoreactive T cells against myelin is also described. It is imperative that further studies on SARS-CoV-2 neuroinvasion address the adverse effects of the virus on myelin and exacerbation of MS symptoms, as nearly 3 million people suffer from MS worldwide.

Oral Dimethyl Fumarate Targets HCA2-Expressing Skin Cells in the Imiquimod Mouse Model

Oral dimethyl fumarate (DMF) is widely used for the systemic treatment of psoriasis in European countries and for multiple sclerosis worldwide (Landeck et al., 2018; Miller et al., 2015). DMF is rapidly hydrolyzed to monomethyl fumarate (MMF) in vivo (Mrowietz et al., 2018), and DMF is not detectable in the blood of patients or healthy individuals after oral administration (Rostami-Yazdi et al., 2010). Despite extensive research, a defined mode of action for oral DMF treatment has yet to be fully explained.

PECULIARITIES OF THE COURSE, DIAGNOSIS, AND TREATMENT OF MULTIPLE SCLEROSIS

Introduction. Multiple sclerosis (MS) is a chronic progressive disease of the central nervous system, which is characterized by demyelination and degeneration of nerve fibers and has a polymorphic clinical picture and a tendency to an unfavourable course [1]. The disease usually affects young and working-age people, leading to early disability and poor quality of life, which makes it a socially significant problem of our time [2]. The main objective was to increase the efficiency of diagnosis and treatment of patients with multiple sclerosis based on a comprehensive analysis of clinical-neurological, psychodiagnostic, and neuroimaging features of the onset and course of the disease. Materials and Methods: Clinical and neurological examination of patients using the Functional System Score (FSS) and Expanded Disability Status Scale (EDSS); cognitive functions examination using the Mini-Mental State Examination (MMSE), the clock-drawing test, the five-word test; brain magnetic resonance imaging; the 36-Item Short Form Health Survey (SF-36). According to statistics, there are about 3 million patients with multiple sclerosis worldwide. In Ukraine, about 20,000 people have multiple sclerosis. Currently, a hypothesis has been made about multiple sclerosis as a multifactorial disease that is, to a great extent, attributable to genetic predisposition (i. e., features of the immune reaction) and the influence of external factors [1]. Multiple sclerosis mainly affects young and mature people – 12 to 55 years old. Although multiple sclerosis can sometimes make its debut in puberty, however, the frequency of the disease gradually increases with age up to the middle of the third decade of life, with a subsequent decrease up to the age of 50–60 [3]. Recently, a trend toward the rejuvenation of multiple sclerosis has been observed. About 3% of all patients with multiple sclerosis are children under 16. Multiple sclerosis debuting at a later age is not sufficiently studied and is rarely diagnosed, although in about 20% of patients, the first signs of this pathology appear after age 40 [4, 11].

The North American Registry for Care and Research in Multiple Sclerosis (NARCRMS).

Although many regional multiple sclerosis (MS) databases existed in the United States and Canada, there was no single clinician-derived registry that examined this disease as a group across the North American continent. This distinction is important because information that results from such a database can potentially give perspectives about MS that cannot be derived from any single regional registry. A partnership was forged between the pharmaceutical industry and the Consortium of Multiple Sclerosis Centers (CMSC) to create a registry of patients with MS from Canada and the United States, including Puerto Rico. Case report forms were created to collect physician-derived information, and the Patient-Reported Outcomes Measurement Information System (PROMIS) was selected to capture patient-reported outcomes. As of November 2021, 754 of 1000 patients have been enrolled. Completion of recruitment is expected by the end of 2021. Twenty-five centers are participating, with an expected total of 30, including five centers from Canada. Clinical status, health economic outcomes, magnetic resonance images, and, soon, biomarkers relevant to understanding relapses and progression are collected. The short-term goal is to understand and better treat MS disease progression, and the long-term goal is its prevention. The North American Registry for Care and Research in Multiple Sclerosis (NARCRMS) is one of few clinician/patient-generated registries that examines MS across North America, including Puerto Rico. Information derived from the natural history studies should help physicians, the pharmaceutical industry, and regulatory bodies understand MS better and improve quality of life for patients with MS worldwide.

ОСОБЕННОСТИ ДЕТСКОГО РАССЕЯННОГО СКЛЕРОЗА

Background. Demyelinating diseases are one of the most pressing and debatable problems in neurology. Despite the emergence of improved diagnostic criteria and new directions in therapy, multiple sclerosis is a leading cause of disability among young patients. According to epidemiological studies, about 3 million people worldwide suffer from multiple sclerosis. At the same time, from 2.7 to 10.5% of all cases of multiple sclerosis worldwide are observed in children under the age of 18, with a tendency towards an increase in the disease incidence. Purpose. To analyze the results of scientific studies of cases of childhood multiple sclerosis. Material and methods. A qualitative analysis of Russian-language and English-language literature sources containing data on cases of childhood multiple sclerosis has been carried out. Results. It has been established that the incidence of multiple sclerosis among pediatric patients is significantly lower in comparison with the adult population. The clinical picture is polymorphic and, in some cases, atypical. Conclusions. Current understanding of the term "pediatric multiple sclerosis" indicates a narrow window of onset with cognitive decline different from adults, combined with a higher number of relapses and more inflammatory lesions compared to adult multiple sclerosis. The polymorphic clinical picture and atypical manifestations of multiple sclerosis in childhood, as well as the debut in the form of a clinically isolated syndrome, can complicate early differential diagnosis and increase the interval from the onset of the disease to the administration of the necessary pharmacotherapy, which can reduce the severity of the course of the disease, the frequency of relapses and increase the interval "debut - disability".

Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition

Background: High-quality epidemiologic data worldwide are needed to improve our understanding of disease risk, support health policy to meet the diverse needs of people with multiple sclerosis (MS) and support advocacy efforts. Objectives: The Atlas of MS is an open-source global compendium of data regarding the epidemiology of MS and the availability of resources for people with MS reported at country, regional and global levels. Methods: Country representatives reported epidemiologic data and their sources via survey between September 2019 and March 2020, covering prevalence and incidence in males, females and children, and age and MS type at diagnosis. Regional analyses and comparisons with 2013 data were conducted. Results: A total of 2.8 million people are estimated to live with MS worldwide (35.9 per 100,000 population). MS prevalence has increased in every world region since 2013 but gaps in prevalence estimates persist. The pooled incidence rate across 75 reporting countries is 2.1 per 100,000 persons/year, and the mean age of diagnosis is 32 years. Females are twice as likely to live with MS as males. Conclusions: The global prevalence of MS has risen since 2013, but good surveillance data is not universal. Action is needed by multiple stakeholders to close knowledge gaps.

The impact of physical exercise on the fatigue symptoms in patients with multiple sclerosis: a systematic review and meta-analysis

BackgroundDespite many benefits of the physical activity on physical and mental health of patients with Multiple Sclerosis (MS), the activity level in these patients is still very limited, and they continue to suffer from impairment in functioning ability. The main aim of this study is thus to closely examine exercise’s effect on fatigue of patients with MS worldwide, with particular interest on Iran based on a comprehensive systematic review and meta-analysis.MethodsThe studies used in this systematic review were selected from the articles published from 1996 to 2019, in national and international databases including SID, Magiran, Iranmedex, Irandoc, Google Scholar, Cochrane, Embase, ScienceDirect, Scopus, PubMed and Web of Science (ISI). These databases were thoroughly searched, and the relevant ones were selected based on some plausible keywords to the aim of this study. Heterogeneity index between studies was determined using Cochran’s test and I2. Due to heterogeneity in studies, the random effects model was used to estimate standardized mean difference.ResultsFrom the systematic review, a meta-analysis was performed on 31 articles which were fulfilled the inclusion criteria. The sample including of 714 subjects was selected from the intervention group, and almost the same sample size of 720 individuals were selected in the control group. Based on the results derived from this meta-analysis, the standardized mean difference between the intervention group before and after the intervention was respectively estimated to be 23.8 ± 6.2 and 16.9 ± 3.2, which indicates that the physical exercise reduces fatigue in patients with MS.ConclusionThe results of this study extracted from a detailed meta-analysis reveal and confirm that physical exercise significantly reduces fatigue in patients with MS. As a results, a regular exercise program is strongly recommended to be part of a rehabilitation program for these patients.

Differential diagnosis of multiple sclerosis in Latin America.

Improvement of multiple sclerosis (MS) diagnoses leads to earlier and correct disease management. The differential diagnostic workup for MS comprises a large variety of medical conditions. There are general guidelines and criteria for diagnosing MS worldwide, but awareness of regional differences needs to be kept in mind. Latin American patients who are screened for MS diagnoses may require an approach that is not exactly the same as that used for patients in North America, western Europe or Asia. In the present review, the conditions that are important for the differential diagnoses of MS in Latin America are reviewed. They include infections, metabolic diseases, nutritional deficits and other autoimmune conditions that physicians in charge of these patients need to be familiar with.

Registry-Based Incidence of Multiple Sclerosis in Southwestern Iran, 2001-2014

Multiple Sclerosis (MS) is the most common cause of neurological disability in young adults. It is estimated that more than two million people have MS worldwide. This study aimed to assess the incidence of MS and its associated factors in Shiraz, Southwestern Iran. Data related to the inci-dence of MS were obtained from the MS center of Shiraz University of Medical Sciences from 2001 to 2014. The study participants were all residents of Shiraz. The subjects were diagnosed with MS by neurologists (all newly diagnosed patients from 2001-2014) and were registered in MS center to receive treatment. Descriptive statistics and univariate and multivariate Poisson re-gression analysis were done. During the study period, 2637 eligible patients were identified. The highest incidence of MS occurred in 2011 and 2012 (17.62, 95% CI: 8.02-38.72 and 16.92, 95% CI: 6.23-45.88 per 100,000 respectively). Besides, the female to male ratio was 2.95 and 44.71% of the MS patients (1070 cases) were in the 20-30 years’ age group. In addition, the mean age of the patients was 30.18±8.86 years. The results showed a significant difference among different age and sex groups regarding the incidence of MS (p=0.01). Moreover, a significant relationship was observed between education level and incidence of MS (p=0.03). The incidence of MS has in-creased in the south of Iran more than other regions.

Co‐Delivery of Disease Associated Peptide and Rapamycin via Acetalated Dextran Microparticles for Treatment of Multiple Sclerosis

Multiple sclerosis (MS) is an inflammatory disease of the central nervous system. While 2.5 million people are affected by MS worldwide, there is no cure other than ameliorating the symptoms through broad immune suppression, which leads to side effects, including increased risks of infection and cancer development. Therefore, tolerance induction specific to disease‐associated antigens serves as a promising alternative as it inhibits disease progression without sacrificing immune competence. In this study, the authors show the efficacy of acetalated dextran (Ace‐DEX) microparticles (MPs) as a potential MS treatment. Ace‐DEX MPs encapsulating ovalbumin (OVA) and the immunosuppressant rapamycin (Rapa) substantially inhibits the inflammation in OVA‐induced delayed‐type hypersensitivity reactions. When tested as a therapeutic treatment for experimental autoimmune encephalomyelitis, the mouse model for MS, MPs containing Rapa, and disease‐associated proteolipid protein (PLP) (Rapa/PLP/MPs) inhibits disease progression, lowers the clinical score, and suppresses the production of inflammatory cytokines (e.g., interferon gamma, interleukin‐17A, and granulocyte‐macrophage colony‐stimulating factor) in splenocytes isolated from treated mice. Rapa/PLP/MPs in vitro also promotes Foxp3 expression, inhibits pro‐inflammatory cytokine production, and dampens T cell proliferation, suggesting the differentiation of antigen‐specific regulatory T cells. Together these data illustrate the promise of a MS treatment using a polymeric particulate delivery platform via the induction of antigen‐specific T cell tolerance.

Pediatric multiple sclerosis: Clinical features and outcome.

Multiple sclerosis (MS) in children manifests with a relapsing-remitting MS (RRMS) disease course. Acute relapses consist of new neurologic deficits persisting greater than 24 hours, in the absence of intercurrent illness, and occur with a higher frequency early in the disease as compared to adult-onset RRMS. Most pediatric patients with MS recover well from these early relapses, and cumulative physical disability is rare in the first 10 years of disease. Brainstem attacks, poor recovery from a single attack, and a higher frequency of attacks portend a greater likelihood of future disability. Although prospective pediatric-onset MS cohorts have been established in recent years, there remains very limited prospective data detailing the longer-term clinical outcome of pediatric-onset MS into adulthood. Whether the advent of MS therapies, and the largely off-label access to such therapies in pediatric MS, has improved prognosis is unknown. MS onset during the key formative academic years, concurrent with active cognitive maturation, is an important determinant of long-term outcome, and is discussed in detail in another article in this supplement. Finally, increasing recognition of pediatric MS worldwide, recent launch of phase III trials for new agents in the pediatric MS population, and the clear imperative to more fully appreciate health-related quality of life in pediatric MS through adulthood highlight the need for standardized, validated, and robust outcome measures.

Pharmacogenetics of multiple sclerosis: personalized therapy with immunomodulatory drugs.

Pharmacogenetic (PG) studies aim to discover the individual genetic background that underlies the heterogeneity of treatment response, and thus find biomarkers for identification of individual patients who will benefit the most from the therapy administered or urgently require the alternate drug. Over the last decade, PG studies have made progress in terms of multiple sclerosis (MS), which is one of the most severe neurodegenerative diseases of the central nervous system. With the understanding of the role of the immune system in the pathogenesis of MS, a number of immunomodulatory drugs were developed for MS treatment management. However, clinical response to these disease-modifying therapies varies in individual patients. Interferon-β and glatiramer acetate showed the most reliable long-term safety and remain among the first-line disease-modifying therapies for MS worldwide. Here, we will review the results of interferon-β and glatiramer acetate PG studies with a detailed analysis of study design and approaches, their advantages and limitations, and future perspectives.

PSEUDOTUMORAL FORM OF MULTIPLE SCLEROSIS WITH SYMPTOMATIC CONVULSIVE SEIZURES (A CLINICAL CASE)

Multiple sclerosis (MS) is prominent among central nervous system diseases. It affects chiefly young people and almost inevitably results in disability. In the past decade, there has been an upward trend for the prevalence of MS worldwide; in particular, the higher prevalence of this disease has been registered in the Moscow Region, which is associated with both an objective increase in its morbidity and improvement of specialized care to the population in the region. MS is characterized by a variety of clinical manifestations. However, paroxysmal disturbances are referred to as the rare symptoms of MS: the incidence of epileptic seizures in this condition is 0.89 to 7.5% according to the literature data. In addition to the clinical form of MS, there are its rare malignant atypical forms that also include its pseudotumoral form characterized by intrinsic neuroimaging and clinical signs that are different from the classical form of MS and another abnormality of the central nervous system. The pseudotumoral form of MS is characterized by the development of acute focal demyelination that appears as a large focus of an increased magnetic resonance signal with perifocal edema as evidenced by magnetic resonance imaging. A pseudotumoral focus of demyelination can occur both at the onset of MS and during its recurrent course. The atypical onset of MS is a special challenge because of diagnostic problems, which may lead to erroneous therapeutic policy and have a negative impact on the late prognosis of the disease. The authors provide a clinical case of the pseudotumoral form of MS with convulsive seizures at the onset of demyelinating disease. The problems of diagnosis and therapeutic approaches are discussed.