title: Catastrophic brain relapse in seronegative NMO after a single dose of natalizumab.
abstract: Natalizumab, an effective treatment for MS, has been shown to exacerbate neuromyelitis optica (NMO) with aquaporin-4 antibodies, but whether this is the case in antibody negative NMO and atypical MS/NMO spectrum disorder overlap syndromes is unknown. We describe a patient with a relapsing optico-spinal demyelinating syndrome, negative for aquaporin-4 antibodies, who experienced a catastrophic brain relapse shortly after a single dose of natalizumab, highlighting that MS immunomodulatory drugs may worsen demyelination in patients with seronegative NMO and atypical MS/NMO overlap syndromes even if they are aquaporin-4 antibody negative. We summarise the treatments considered safe and effective in NMO, and those with potential to exacerbate disease.
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK. Electronic address: jokitley@doctors.org.uk.
authors.forename: Joanna
authors.initials: J
authors.lastname: Kitley
authors.affiliation: Queen's Medical Centre, University of Nottingham, Nottingham, UK. Electronic address: Nikos.Evangelou@nottingham.ac.uk.
authors.forename: Nikos
authors.initials: N
authors.lastname: Evangelou
authors.affiliation: Department of Neuroradiology, Oxford University Hospitals NHS Trust, Oxford, UK. Electronic address: Wilhelm.kueker@ouh.nhs.uk.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Küker
authors.affiliation: The Walton Centre for Neurology and Neurosurgery, Liverpool, UK. Electronic address: anu.jacob@thewaltoncentre.nhs.uk.
authors.forename: Anu
authors.initials: A
authors.lastname: Jacob
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK. Electronic address: maria.leite@imm.ox.ac.uk.
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Leite
authors.affiliation: Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK. Electronic address: jacqueline.palace@ndcn.ox.ac.uk.
authors.forename: Jackie
authors.initials: J
authors.lastname: Palace
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D001921:Brain / Q000187:drug effects* / Q000473:pathology*; D002388:Catastrophic Illness; D005260:Female; D006801:Humans; D039441:Integrin alpha4; D000069442:Natalizumab; D009471:Neuromyelitis Optica / Q000097:blood / Q000188:drug therapy*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069442:Natalizumab; D039441:Integrin alpha4
keywords: AQP4; Aquaporin-4; Devic's disease; NMO; Natalizumab; Neuromyelitis optica