Abstract
We report the case of a woman with multiple sclerosis who developed a severe neurological condition following natalizumab (NZB) withdrawal and soon after fingolimod (FTY) initiation. FTY was started 3.5 months after a two-year NZB treatment. Fifteen days later, she suffered partial repetitive seizures followed by a tonicoclonic seizure. This was associated with attention difficulties and an increased asthenia. Brain MRI follow-up disclosed large demyelinating active lesions in favour of disease reactivation. This case suggests that FTY introduction may occur less than three months after NZB withdrawal.
MeSH terms
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Adult
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Antibodies, Monoclonal, Humanized / administration & dosage*
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Antibodies, Monoclonal, Humanized / adverse effects
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Asthenia / etiology
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Disease Progression
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Drug Administration Schedule
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Drug Substitution*
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Epilepsies, Partial / etiology
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Epilepsy, Tonic-Clonic / etiology
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Female
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Fingolimod Hydrochloride
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Humans
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Immunologic Factors / administration & dosage*
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Immunologic Factors / adverse effects
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Magnetic Resonance Imaging
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Multiple Sclerosis, Relapsing-Remitting / complications
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Multiple Sclerosis, Relapsing-Remitting / diagnosis
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Multiple Sclerosis, Relapsing-Remitting / drug therapy*
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Natalizumab
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Propylene Glycols / administration & dosage*
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Severity of Illness Index
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Sphingosine / administration & dosage
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Sphingosine / analogs & derivatives*
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Time Factors
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Treatment Outcome
Substances
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Antibodies, Monoclonal, Humanized
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Immunologic Factors
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Natalizumab
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Propylene Glycols
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Fingolimod Hydrochloride
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Sphingosine