Severe multiple sclerosis reactivation under fingolimod 3 months after natalizumab withdrawal.
We report the case of a woman with multiple sclerosis who developed a severe neurological condition following natalizumab (NZB) withdrawal and soon after fingolimod (FTY) initiation. FTY was started 3.5 months after a two-year NZB treatment. Fifteen days later, she suffered partial repetitive seizures followed by a tonicoclonic seizure. This was associated with attention difficulties and an increased asthenia. Brain MRI follow-up disclosed large demyelinating active lesions in favour of disease reactivation. This case suggests that FTY introduction may occur less than three months after NZB withdrawal.
Department of Neurology, CHU de Reims, Reims, France.
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Daelman
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Maitrot
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Maarouf
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Chaunu
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Papeix
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Tourbah
D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000009:adverse effects; D001247:Asthenia / Q000209:etiology; D018450:Disease Progression; D004334:Drug Administration Schedule; D057915:Drug Substitution; D004828:Epilepsies, Partial / Q000209:etiology; D004830:Epilepsy, Tonic-Clonic / Q000209:etiology; D005260:Female; D000068876:Fingolimod Hydrochloride; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage* / Q000009:adverse effects; D008279:Magnetic Resonance Imaging; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D000069442:Natalizumab; D011409:Propylene Glycols / Q000008:administration & dosage*; D012720:Severity of Illness Index; D013110:Sphingosine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D013997:Time Factors; D016896:Treatment Outcome
D061067:Antibodies, Monoclonal, Humanized; D007155:Immunologic Factors; D000069442:Natalizumab; D011409:Propylene Glycols; D000068876:Fingolimod Hydrochloride; D013110:Sphingosine