If caught early, Natalizumab-PML not fatal for multiple sclerosis patients

Successful Management of Natalizumab-Associated Progressive Multifocal Leukoencephalopathy (PML) and Immune Reconstitution Syndrome (IRIS) in a Patient With Multiple Sclerosis
Alexandra Schröder, MD; De-Hyung Lee, MD; Kerstin Hellwig, MD;
Carsten Lukas, MD; Ralf A. Linker, MD; Ralf Gold, MD
Arch Neurol. Published online July 12, 2010. doi:10.1001/archneurol.2010.157


Objective To describe a case of successful clinical management of natalizumab-associated progressive multifocal leukoencephalopathy(PML) and immune reconstitution syndrome (IRIS) in a patient with multiple sclerosis.


Design Case report.


Setting University hospital.


Patient A 41-year-old woman with relapsing-remitting multiple sclerosis developed PML after 29 natalizumab infusions.


Interventions Immediate plasma exchange was combined for removal of natalizumab with application of mefloquine and mirtazapine to limit viral replication and oligodendrocyte infection. A subsequent IRIS was treated with glucocorticosteroids.


Results After 3 months of treatment, cerebrospinal fluid tested negative for JC virus. There was a favorable outcome, and the Expanded Disability Status Scale score remained stable at 3.5 compared with before PML.


Conclusions In the setting of early diagnosis and consequent treatment, natalizumab-associated PML can be well managed in some cases. This situation differs from the course of PML in other conditions, eg, after the application of depleting monoclonal antibodies, in which irreversible cellular effects are associated with very high mortality.


Author Affiliations: Departments of Neurology (Drs Schröder, Lee, Hellwig, Linker, and Gold); and Radiology (Dr Lukas), St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.


SOURCE: Archives of Neurology  - July 12, 2010 - 


Read more of this, from Lori Friend, a writer for the examiner.com by clicking here

*

Share |

*

***********************************************************

"Providing You with 'MS Views and News', is what we do"

Keep Informed and up-to-date with information concerning

 Multiple Sclerosis when registered at

the MS Views and News website.

(This will take 20-25 seconds and will empower you

 with informaton and learning)

Thank you for allowing me to help to keep you informed

****************************************************************