The aim of this study is to evaluate the treatment responses and prognosis of Marburg variant multiple sclerosis (MS) through a systematic review of case reports.

Marburg variant multiple sclerosis is a rare, aggressive MS form, often leading quickly to severe disability or death. Its rapid progression and high morbidity highlight the need for effective treatment. Limited data on incidence and optimal management underscore the importance of this review in evaluating treatment outcomes and improving prognosis.

A systematic review of case reports on Marburg variant multiple sclerosis was conducted in accordance with PRISMA guidelines. Comprehensive searches were performed across four electronic databases—PubMed, Scopus, Embase, and WoS—up to September 2024. A total of 1633 records were screened, resulting in 18 studies meeting the inclusion and exclusion criteria. Demographic, clinical, and radiological data were extracted for each patient and synthesized into a qualitative analysis.

Eighteen patients with Marburg variant MS were included, with a mean age of 34.9 ± 13.7 years; 88.9% (16/18) were female. Of the 14 patients who underwent lumbar puncture, 71% (10/14) demonstrated lymphocytic pleocytosis, 64% (9/14) had elevated protein levels, and 50% (7/14) presented positive oligoclonal bands. All were negative for anti-MOG and anti-AQP-4 antibodies. T2/FLAIR lesions appeared hyperintense in all cases, with 55% located in periventricular white matter, 22% in subcortical regions, and ring enhancement observed in 28%. Disease progression was noted in 50% (9/18) on follow-up MRI. Treatment included intravenous steroids (100%), plasmapheresis (67%), and cyclophosphamide (61%), followed by maintenance therapies such as ocrelizumab, rituximab, or alemtuzumab. Overall, 78% (14/18) experienced significant clinical and radiological improvement, 11% (2/18) achieved complete remission (EDSS ≤1.5), and 11% (2/18) died within the first few weeks.

Marburg variant MS, primarily affecting young women, demonstrates clinical and radiological improvement with aggressive treatment, though early mortality underscores the need for prompt intervention