Article (Scientific journals)
The earlier the smaller the better for natalizumab-associated PML: in MRI vigilance veritas ?
PHAN BA, Remy; Belachew, Shibeshih; Outteryck, Olivier et al.
2012In Neurology, 79, p. 1065-1067
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Keywords :
PML; Natalizumab; MRI; JC virus; Multiple sclerosis
Abstract :
[en] Natalizumab-associated progressive multifocal leukoencephalopathy (N-PML) in multiple sclerosis (MS) is due to CNS infection by the opportunistic JC virus (JCV). As of december 2011, 193 confirmed cases of N-PML have been observed, giving rise to an overall risk of approximately 0,202%. N-PML pathogenesis remains partially elusive although risk factors have now been clearly delineated. In patients with prior JCV infection detected by serum anti-JCV antibodies, duration of therapy and prior use of immunosuppressants (IS) increase the risk of N-PML. The clinical outcome of MS patients who developed N-PML was highly variable, ranging from asymptomatic case to varying degrees of neurological disability or even death. It was also observed in real life setting that the earlier N-PML was diagnosed and treated, the better was the clinical outcome. Clinical vigilance is now considered as the established cornerstone of PML risk-management algorithm. Here we present early MRI features of 4 out of 8 N-PML cases, which were observed in Wallonia-Brussels and Northern France in more than 4 years of post-marketing utilization of natalizumab for both regions. We are not aware of the specific context and outcome of the 4 other N-PML cases, which were diagnosed and treated in other centers. The reported cases emphasize that (i) N-PML can have a long presymptomatic course while still being clearly detectable with MR imaging, (ii) N-PML can have a benign outcome provided it is diagnosed and treated early, (iii) a clinically symptomatic N-PML may be a further advanced infection with a poorer prognosis, and (iv) periodic brain MR scans, particularly in high risk situations, are likely to provide earlier detection of N-PML and better outcomes.
Disciplines :
Neurology
Author, co-author :
PHAN BA, Remy ;  Centre Hospitalier Universitaire de Liège - CHU > Neurologie Sart Tilman
Belachew, Shibeshih ;  Université de Liège - ULiège > Département des sciences cliniques > Neurologie
Outteryck, Olivier;  Salengro Hospital, Université de Lille Nord de France, CHRU Lille, France > Neurology
Moonen, Gustave  ;  Université de Liège - ULiège > Département des sciences cliniques > Neurologie
Sindic, Christian;  Cliniques Universitaires Saint-Luc, UC Louvain, Brussels > Neurologie
Vokaer, Mathieu;  Clinical Neuroimmunology Unit, University Hospital Erasme, Brussels > Neurology
Vermersch, Patrick;  Salengro Hospital, Université de Lille Nord de France, CHRU Lille, France > Neurology
Language :
English
Title :
The earlier the smaller the better for natalizumab-associated PML: in MRI vigilance veritas ?
Publication date :
September 2012
Journal title :
Neurology
ISSN :
0028-3878
eISSN :
1526-632X
Publisher :
Lippincott Williams & Wilkins, Hagerstown, United States - Maryland
Volume :
79
Pages :
1065-1067
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 27 March 2012

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