The Marburg variant of multiple sclerosis is extremely rare but also the most severe. Life expectancy has been weeks or months, but advances in treatment have led to an improved outlook.

Multiple sclerosis (MS) is an autoimmune disease affecting the brain and spinal cord. Worldwide, an estimated 2.8 million people currently have MS, and its incidence is rising.

MS causes autoimmune demyelination, a loss of the protective coating around your nerve fibers. Eventually, it damages your nerve cells and fibers themselves, leaving behind scarring, or “sclerosis.” MS disrupts regular nervous system communication and function, causing a range of serious neurological symptoms.

Doctors categorize MS into different types, each marked by varying symptom frequency and degrees of progression. The Marburg variant of MS, also called malignant, fulminant, or rapidly progressive MS, is the most aggressive form of the disease. Some scientists consider it to be a form of tumefactive MS, which has symptoms similar to a brain tumor.

But Marburg MS is also very rare, representing fewer than 4% of MS cases.

The Marburg variant of MS is a severe and rapidly progressive form of MS. Symptoms usually develop abruptly and worsen quickly.

Compared with other forms of MS, the Marburg variant is more likely to cause sudden-onset confusion or altered consciousness, which usually brings people to seek urgent care.

Other symptoms may include:

There’s no single test to diagnose MS. Instead, a series of lab and imaging studies can check for suggestive signs of MS and rule out other neurological conditions.

Marburg MS is very rare, and your doctors will need to differentiate it from other conditions like:

Doctors will begin by reviewing your symptoms and performing a physical and neurological examination.

If they suspect MS, a contrast-enhanced brain MRI can reveal characteristic demyelinating lesions in the brain and spinal cord.

A spinal tap and cerebrospinal fluid (CSF) analysis may show specific antibodies common in MS, called oligoclonal bands (OCBs). CSF analysis may also show signs of other illnesses, such as infections.

Blood tests can help rule out other causes of your symptoms, including infections, deficiencies, and other autoimmune conditions.

Doctors may also order electroencephalogram (EEG) testing to monitor brainwave activity, especially if they suspect seizures or if your consciousness is altered.

Eye symptoms and involvement of the optic nerve are common in MS. Depending on your symptoms, doctors may assess your optic nerves and check visual evoked potentials to see the brainwaves produced by certain types of visual stimuli.

In very rare circumstances, doctors may need to perform a brain biopsy to confirm the diagnosis.

There is presently no known cure for Marburg MS.

Because the initial symptoms are severe and can worsen quickly, people with Marburg MS usually require hospitalization during the diagnostic process. As soon as possible, doctors will initiate aggressive treatment in the hospital.

Treatment for Marburg MS may include:

Recent case reports have described successful aggressive treatment of Marburg MS using infusions of chemotherapeutic drugs (mitoxantrone, cyclophosphamide) and monoclonal antibodies (alemtuzumab, ocrelizumab).

As symptoms stabilize, doctors may also recommend physical or occupational therapy and treatment for associated conditions, like depression, spasticity, or bladder dysfunction.

The Marburg variant is a very uncommon form of MS that can be rapidly fatal. Historically, life expectancy after diagnosis of Marburg MS has been weeks to months due to progressive, unremitting neurologic symptoms.

However, MS treatment continues to advance.

Although the Marburg variant is extremely rare, recent case reports suggest that some people who receive rapid, intensive treatment can remain stable for up to 3 years. A 2021 paper described successful stabilization and a near-full recovery of Marburg MS. Another 2022 case report described complete disease remission at 6 months.

As in other types of MS, the precise cause of Marburg MS is unknown.

Doctors suspect a mix of genetic and environmental risk factors combine to trigger your immune system, which then begins mistakenly attacking the myelin that makes up your nerve sheaths. Ultimately, this autoimmune process damages and scars your nerve cells and fibers.

White blood cells called T cells initially mediate your immune system response and inflammation. But other types of cells and compounds also become involved in the process of nervous system inflammation and sclerosis.

The severe and rapidly progressive nature of the symptoms of Marburg MS is due to both the extreme inflammation and the widespread nature of the MS lesions in critical locations such as your brainstem.

Doctors aren’t sure of the precise combination of risk factors that provoke MS, nor what causes the autoimmune process to trigger so intensely in the Marburg variant.

We do know that the Marburg variant is quite rare and mainly affects young adults.

More risk factors for MS include:

  • sex assigned female at birth
  • European descent
  • first-degree family history of MS
  • genetic risk factors and mutations (likely multiple different gene effects combined)
  • certain infections, like Epstein-Barr virus and Mycoplasma pneumoniae
  • cigarette smoking
  • obesity
  • lack of sunlight exposure and residing further from the equator

MS is an autoimmune demyelinating disease of the brain and spinal cord. Though MS can cause significant symptoms and disability in all its forms, the Marburg variant is the rarest and most severe form of the disease.

Marburg MS usually arises in young adults. In Marburg MS, severe neurologic symptoms like confusion and paralysis can appear suddenly and progress rapidly.

Previously, Marburg MS has been uniformly and swiftly fatal. But promising advances in MS therapy have improved survival, achievement of disease stability, and chances of remission with aggressive treatment.