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Abstract

Progressive multifocal leucoencephalopathy has become a growing concern in natalizumab-treated multiple sclerosis patients. Here, we describe a 35-year-old patient who was treated with 34 infusions of natalizumab before complaining about visual deterioration. MRI was non-diagnostic and JC virus testing initially was negative. Electroencephalography showed severe slowing of the right hemisphere, and neuropsychological testing revealed right frontal and temporal deficits. The diagnosis of progressive multifocal leucoencephalopathy was established 2 months later by typical MRI presentation and detection of JC virus DNA in the cerebrospinal fluid. Functional neurological deficits may precede imaging features and should prompt early consideration of progressive multifocal leucoencephalopathy.

Keywords

electroencphalography multiple sclerosis natalizumab MRI progressive multifocal leucoencephalopathy

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References

Major EO Progressive multifocal leukoencephalopathy in patients on immunomodulatory therapies. Annu Rev Med 2010; 61: 35-47.

Yousry TA , Major EO , Ryschkewitsch C. , et al. Evaluation of patients treated with natalizumab for progressive multifocal leukoencephalopathy. N Engl J Med 2006; 354: 924-933.

Kappos L. , Bates D. , Hartung HP , et al. Natalizumab treatment for multiple sclerosis: recommendations for patient selection and monitoring. Lancet Neurol 2007; 6: 431-441.

Polman CH , O’Connor PW , Havrdova E. , et al. A randomized, placebo-controlled trial of natalizumab for relapsing multiple sclerosis. N Engl J Med 2006; 354: 899-910.

Linda H. , von Heijne A. , Major EO , et al. Progressive multifocal leukoencephalopathy after natalizumab monotherapy. N Engl J Med 2009; 361: 1081-1087.

Wenning W. , Haghikia A. , Laubenberger J. , et al. Treatment of progressive multifocal leukoencephalopathy associated with natalizumab. N Engl J Med 2009; 361: 1075-1080.

Aksamit AJ Progressive multifocal leukoencephalopathy. Curr Treat Options Neurol 2008; 10: 178-185.

Krupp LB , Lipton RB , Swerdlow ML , et al. Progressive multifocal leukoencephalopathy: clinical and radiographic features. Ann Neurol 1985; 17: 344-349.

Farrell DF The EEG in progressive multifocal leukoencephalopathy. Electroencephalogr Clin Neurophysiol 1969; 26: 200-205.

10.

Lima MA , Drislane FW , Koralnik IJ Seizures and their outcome in progressive multifocal leukoencephalopathy. Neurology 2006; 66: 262-264.

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