title: Tumefactive multiple sclerosis lesions in two patients after cessation of fingolimod treatment.
abstract: BACKGROUND
  Fingolimod (FTY) is the first oral medication approved for multiple sclerosis therapy. Until now, little has been known about the effects of FTY withdrawal regarding disease activity and development of tumefactive demyelinating lesions (TDLs), as already described in patients who discontinue natalizumab.
  
  
  METHODS
  In this study we present the clinical and radiological findings of two patients who had a severe rebound after FTY withdrawal and compare these with patients identified by a PubMed data bank analysis using the search term 'fingolimod rebound'. In total, 10 patients, of whom three developed TDLs, are presented.
  
  
  RESULTS
  Patients suffering from TDLs were free of clinical and radiological signs of disease activity under FTY therapy (100% versus 57%, compared with patients without TDLs) and had rebounds after a mean of 14.6 weeks (standard deviation 11.5) [patients without TDLs 11.7 (standard deviation 3.4)].
  
  
  CONCLUSIONS
  We propose that a good therapeutic response to FTY might be predisposing for a severe rebound after withdrawal. Consequently, therapy switches should be planned carefully with a short therapy free interval.
authors.affiliation: Department of Neurology, St Josef-Hospital, Ruhr-University Bochum,Gudrunstr. 56, 44791 Bochum, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Faissner
authors.affiliation: Department of Neurology, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Hoepner
authors.affiliation: Department of Radiology, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Lukas
authors.affiliation: Department of Neurology, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Andrew
authors.initials: A
authors.lastname: Chan
authors.affiliation: Department of Neurology, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Gold
authors.affiliation: Department of Neurology, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
authors.forename: Gisa
authors.initials: G
authors.lastname: Ellrichmann
keywords: FTY withdrawal/discontinuation; FTY/fingolimod response; disease-modifying therapy; multiple sclerosis; rebound; therapy switch