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J Neurol Sci. 2014 Apr 15;339(1-2):223-5. doi: 10.1016/j.jns.2014.01.035. Epub 2014 Feb 4.

Catastrophic brain relapse in seronegative NMO after a single dose of natalizumab.

Author information

1
Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK. Electronic address: jokitley@doctors.org.uk.
2
Queen's Medical Centre, University of Nottingham, Nottingham, UK. Electronic address: Nikos.Evangelou@nottingham.ac.uk.
3
Department of Neuroradiology, Oxford University Hospitals NHS Trust, Oxford, UK. Electronic address: Wilhelm.kueker@ouh.nhs.uk.
4
The Walton Centre for Neurology and Neurosurgery, Liverpool, UK. Electronic address: anu.jacob@thewaltoncentre.nhs.uk.
5
Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK. Electronic address: maria.leite@imm.ox.ac.uk.
6
Nuffield Department of Clinical Neurosciences, Oxford University Hospitals NHS Trust, University of Oxford, Oxford, UK. Electronic address: jacqueline.palace@ndcn.ox.ac.uk.

Abstract

Natalizumab, an effective treatment for MS, has been shown to exacerbate neuromyelitis optica (NMO) with aquaporin-4 antibodies, but whether this is the case in antibody negative NMO and atypical MS/NMO spectrum disorder overlap syndromes is unknown. We describe a patient with a relapsing optico-spinal demyelinating syndrome, negative for aquaporin-4 antibodies, who experienced a catastrophic brain relapse shortly after a single dose of natalizumab, highlighting that MS immunomodulatory drugs may worsen demyelination in patients with seronegative NMO and atypical MS/NMO overlap syndromes even if they are aquaporin-4 antibody negative. We summarise the treatments considered safe and effective in NMO, and those with potential to exacerbate disease.

KEYWORDS:

AQP4; Aquaporin-4; Devic's disease; NMO; Natalizumab; Neuromyelitis optica

PMID:
24576801
DOI:
10.1016/j.jns.2014.01.035
[Indexed for MEDLINE]

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