title: Prophylactic antiepileptic treatment reduces seizure frequency in natalizumab-associated progressive multifocal leukoencephalopathy.
abstract: OBJECTIVE
  Little is known about seizures in natalizumab-associated progressive multifocal leukoencephalopathy (NAT-PML).
  
  
  METHODS
  A review of clinical records of 15 NAT-PML patients with multiple sclerosis (MS) treated at a German university hospital.
  
  
  RESULTS
  Some 53% (8/15) of our patients developed seizures with often multiple semiologies (seven grand mal, three simple partial motor and two psychomotor seizures). Series of seizures or status epilepticus occurred in seven of these eight. Seizure onset was on average 61 days after onset of NAT-PML and was associated with immune reconstitution inflammatory syndrome (IRIS) in five of eight patients. After having observed severe seizures during NAT-PML in seven of our first nine patients, we started preventive antiepileptic treatment (PAT) with levetiracetam (1000-1750 mg/day). Patient subgroups analyzed for seizures and PAT did not differ in baseline characteristics. Only one of six patients, who received PAT, had a seizure compared with seven of nine patients without PAT (2-tailed Fisher's exact test, p = 0.04).
  
  
  CONCLUSIONS
  Although the small sample size and retrospective nature of the study are limitations, we propose to treat NAT-PML patients with PAT early after diagnosis, as seizures seem to be common and severe in NAT-PML.
authors.affiliation: Department of Neurology, Ruhr University Bochum, St Josef-Hospital, Gudrunstr. 56; 44719 Bochum; Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Hoepner
authors.affiliation: Department of Neurology, Ruhr University Bochum, St Josef-Hospital, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Dahlhaus
authors.affiliation: Department of Neurology, Ruhr University Bochum, St Josef-Hospital, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Kollar
authors.affiliation: Department of Neurology, Ruhr University Bochum, St Josef-Hospital, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Zurawski
authors.affiliation: Department of Neurology, Ruhr University Bochum, St Josef-Hospital, Germany.
authors.forename: Andrew
authors.initials: A
authors.lastname: Chan
authors.affiliation: Department of Neurology, Ruhr University Bochum, St Josef-Hospital, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Kleiter
authors.affiliation: Department of Neurology, Ruhr University Bochum, St Josef-Hospital, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Gold
authors.affiliation: Department of Neurology, Ruhr University Bochum, St Josef-Hospital, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Hellwig
keywords: natalizumab; preventive antiepileptic treatment; progressive multifocal leukoence-phalopathy; seizures