期刊
JOURNAL OF CLINICAL NEUROSCIENCE
卷 22, 期 2, 页码 400-401出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.jocn.2014.05.028
关键词
IRIS; Multiple sclerosis; Natalizumab; Plasmapheresis; Rebound; Regulatory T-cells; Restart
资金
- Bayer Vital GmbH
- Novartis
- Biogen Idec
- Merck Serono
- Sanofi-Aventis
- Teva
- Fresenius
We present a 46-year-old woman with a relapse of multiple sclerosis (MS) that began 3 months after withdrawal from long-term treatment with natalizumab. Shortly after restart of a single dose of natalizumab she developed a fulminant MS rebound with stupor and tetraparesis. Cerebral MRI showed massive progression in the number of lesions and tumefactive lesions with ring gadolinium-enhancement. Stereotactic brain biopsy revealed acute demyelination and B-cell dominated inflammation. The patient improved during therapeutic plasma exchange. We speculate that early restart of natalizumab in the case of a relapse may worsen disease evolution possibly by modifying regulatory immune effector processes during an inflammatory rebound phase. A restart of natalizumab in MS patients suffering from a recent relapse or with signs of active inflammation should be considered with caution. (C) 2014 Elsevier Ltd. All rights reserved.
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