Neuroimaging of Natalizumab Complications in Multiple Sclerosis: PML and Other Associated Entities
Open Access
- 21 September 2015
- journal article
- review article
- Published by Hindawi Limited in Multiple Sclerosis International
- Vol. 2015, 1-14
- https://doi.org/10.1155/2015/809252
Abstract
Natalizumab (Tysabri) is a monoclonal antibody (α4 integrin antagonist) approved for treatment of multiple sclerosis, both for patients who fail therapy with other disease modifying agents and for patients with aggressive disease. Natalizumab is highly effective, resulting in significant decreases in rates of both relapse and disability accumulation, as well as marked decrease in MRI evidence of disease activity. As such, utilization of natalizumab is increasing, and the presentation of its associated complications is increasing accordingly. This review focuses on the clinical and neuroimaging features of the major complications associated with natalizumab therapy, focusing on the rare but devastating progressive multifocal leukoencephalopathy (PML). Associated entities including PML associated immune reconstitution inflammatory syndrome (PML-IRIS) and the emerging phenomenon of rebound of MS disease activity after natalizumab discontinuation are also discussed. Early recognition of neuroimaging features associated with these processes is critical in order to facilitate prompt diagnosis, treatment, and/or modification of therapies to improve patient outcomes.Keywords
This publication has 112 references indexed in Scilit:
- Disease course and outcome of 15 monocentrically treated natalizumab-associated progressive multifocal leukoencephalopathy patientsJournal of Neurology, Neurosurgery & Psychiatry, 2013
- Management and outcome of CSF-JC virus PCR-negative PML in a natalizumab-treated patient with MSNeurology, 2011
- MRI preclinical detection and asymptomatic course of a progressive multifocal leucoencephalopathy (PML) under natalizumab therapy: Figure 1Journal of Neurology, Neurosurgery & Psychiatry, 2011
- Natalizumab and drug holiday in clinical practice: An observational study in very active relapsing remitting Multiple Sclerosis patientsJournal of the Neurological Sciences, 2011
- Immune reconstitution inflammatory syndrome in natalizumab-associated PMLNeurology, 2011
- Natalizumab treatment for multiple sclerosis: updated recommendations for patient selection and monitoringThe Lancet Neurology, 2011
- Progressive multifocal leukoencephalopathy and other disorders caused by JC virus: clinical features and pathogenesisThe Lancet Neurology, 2010
- Fulminant JC virus encephalopathy with productive infection of cortical pyramidal neuronsAnnals of Neurology, 2009
- Effect of plasma exchange in accelerating natalizumab clearance and restoring leukocyte functionNeurology, 2009
- Progressive Multifocal Leukoencephalopathy in AIDS: Proton MR Spectroscopy Patterns of Asynchronous Lesions Confirmed by Serial Diffusion-Weighted Imaging and Apparent Diffusion Coefficient MappingJournal of Clinical Neurology, 2007