Immune reconstitution inflammatory syndrome after withdrawal of natalizumab?
Citation Manager Formats
Make Comment
See Comments
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
To the Editor: We would like to report the follow-up of the recent case described by Lenhard et al.1 The patient is now pregnant and had a severe relapse during the second trimester of pregnancy, which was successfully managed with high-dose IV immunoglobulins (IVIg) and corticosteroids.
This patient initially contacted us in her sixth week of pregnancy and 12 days after her last natalizumab infusion to request inclusion in our nationwide multiple sclerosis (MS) and pregnancy registry. Her Expanded Disability Status Scale (EDSS) score was 7.0 and natalizumab treatment had been discontinued. Two months later, the patient relapsed with progressive paresis and astasia.
She was hospitalized (EDSS 9.0), treated with methylprednisolone (5 × 1,000 mg), subsequently stabilized, and referred to a MS rehabilitation clinic. Her neurologic status again deteriorated to an EDSS of 9.5 over the next few days. Upon referral to our department, she was unable to use her upper extremities to turn herself around in a lying position. She developed dysphagia, dysarthria, and altered mental status, as described by Lenhard et al.1
Since a premature delivery may be prompted by steroids,2 we treated her with 1.5 mg/kg body weight IVIg over 3 days. When she stabilized 7 days later, we treated her …
AAN Members
We have changed the login procedure to improve access between AAN.com and the Neurology journals. If you are experiencing issues, please log out of AAN.com and clear history and cookies. (For instructions by browser, please click the instruction pages below). After clearing, choose preferred Journal and select login for AAN Members. You will be redirected to a login page where you can log in with your AAN ID number and password. When you are returned to the Journal, your name should appear at the top right of the page.
AAN Non-Member Subscribers
Purchase access
For assistance, please contact:
AAN Members (800) 879-1960 or (612) 928-6000 (International)
Non-AAN Member subscribers (800) 638-3030 or (301) 223-2300 option 3, select 1 (international)
Sign Up
Information on how to subscribe to Neurology and Neurology: Clinical Practice can be found here
Purchase
Individual access to articles is available through the Add to Cart option on the article page. Access for 1 day (from the computer you are currently using) is US$ 39.00. Pay-per-view content is for the use of the payee only, and content may not be further distributed by print or electronic means. The payee may view, download, and/or print the article for his/her personal, scholarly, research, and educational use. Distributing copies (electronic or otherwise) of the article is not allowed.
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Dr. David Beversdorf and Dr. Ryan Townley
► Watch
Related Articles
- No related articles found.