title: [Cyclophosphamide pulse therapy effective for childhood-onset refractory multiple sclerosis: a case report].
abstract: We report a case of a 15-year-old girl with relapsing-remitting multiple sclerosis (MS) who received cyclophosphamide pulse therapy. At the age of 5 years, she displayed symptoms such as headache and unconsciousness after varicella infection as the first episode of MS. She had been treated with methylprednisolone pulse therapy, intravenous immunoglobulin, interferon-beta1b, and azathioprine. However, she had relapsed 12 times by the age of 15 years. At this time, she showed weakness and severe paralysis of her left leg, and even 1 month after methylprednisolone pulse therapy, she still had gait impairment and showed gadolinium-enhanced lesion on brain magnetic resonance imaging. We then started cyclophosphamide pulse therapy (600 mg/m2) once a month for 12 months combined with interferon-beta1a. She had no serious side effects and she could walk again after 4 months on cyclophosphamide treatment. She has been free from relapse for 2 years and 8 months until the present time. Although only a few studies have indicated the efficacy of cyclophosphamide pulse therapy for childhood MS, we consider careful use of cyclophosphamide could be one of the options for refractory childhood MS.
authors.affiliation: Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka.
authors.forename: Tae
authors.initials: T
authors.lastname: Ikeda
authors.forename: Kuriko
authors.initials: K
authors.lastname: Kagitani-Shimono
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Iwatani
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Kitai
authors.forename: Masaya
authors.initials: M
authors.lastname: Tachibana
authors.forename: Koji
authors.initials: K
authors.lastname: Tominaga
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okinaga
authors.forename: Toshisaburo
authors.initials: T
authors.lastname: Nagai
authors.forename: Keiichi
authors.initials: K
authors.lastname: Ozono
mesh_terms: D000293:Adolescent; D003520:Cyclophosphamide / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D000068556:Interferon beta-1a; D016899:Interferon-beta / Q000627:therapeutic use*; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000175:diagnosis / Q000188:drug therapy*; D055502:Secondary Prevention; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016899:Interferon-beta; D003520:Cyclophosphamide; D000068556:Interferon beta-1a