title: Rebound exacerbation multiple sclerosis following cessation of oral treatment.
abstract: BACKGROUND
  Multiple sclerosis (MS) management is changing, revolutionized by oral agents. Immune Reconstitution Inflammatory Syndrome (IRIS) describes exaggerated response to both exogenous (infective) and endogenous (non-infective) antigens.
  
  
  METHODS
  This paper reports two cases of MS "rebound" following withdrawal of oral treatments.
  
  
  RESULTS
  Two patients, with suboptimal response to interferons, trialled oral MS treatment (fingolimod and BG12) with excellent response. Upon cessation both experienced MS "rebound" which responded to steroids.
  
  
  CONCLUSIONS
  "Rebound" may occur following withdrawal of oral MS therapies. Patients should be advised accordingly and possibly started on alternative treatment before the immunomodulating effect of therapy has subsided.
authors: Department of Neurology, Liverpool Hospital and The South Western Sydney Clinical School, University of New South Wales, New South Wales (NSW), Australia; School of Medicine, Griffith University, Queensland, Australia; Strategic Health Evaluators, PO Box 598, Northbridge, 1560 NSW, Australia. Electronic address: Roy.Beran@unsw.edu.au.
authors: Roy G
authors: RG
authors: Beran
authors: Department of Neurology, Liverpool Hospital and The South Western Sydney Clinical School, University of New South Wales, New South Wales (NSW), Australia.
authors: Yaser
authors: Y
authors: Hegazi
authors: Southern Neurology, 2/19 Kensington Street, Kogarah, NSW, Australia.
authors: Raymond S
authors: RS
authors: Schwartz
authors: Department of Neurology, Liverpool Hospital and The South Western Sydney Clinical School, University of New South Wales, New South Wales (NSW), Australia; Southern Neurology, 2/19 Kensington Street, Kogarah, NSW, Australia.
authors: Dennis J
authors: DJ
authors: Cordato
keywords: BG12; Fingolimod; Multiple sclerosis; Rebound