ArticleNeurology2012
Simultaneous PML-IRIS after discontinuation of natalizumab in a patient with MS.
Article in Neurology, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it, 51 citations in OpenAlex.
- Evidence-based guidelines: MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis--establishing disease prognosis and monitoring patients.Nature reviews. Neurology · 2015Guideline
- Natalizumab-Related Progressive Multifocal Leukoencephalopathy in Multiple Sclerosis: Findings from an Italian Independent Registry.PloS one · 2016Trial
- Temporal shifts in adaptive immunity drive HIV-associated cryptococcal IRIS: mechanisms, models, and therapeutic opportunities.NeuroImmune pharmacology and therapeutics · 2026Article
- Neurovascular pericytes are susceptible to infection by JC polyomavirus.Journal of virology · 2025Article
- Live long and persist: polyomavirus immune evasion in the brain and kidney.Future virology · 2025Article
- The Effect of Intravenous Methylprednisolone on Recurrent Exacerbation in Hematologic Malignancy-associated Progressive Multifocal Leukoencephalopathy.Internal medicine (Tokyo, Japan) · 2021Article
- Epilepsia partialis continua revealing idelalisib-associated PML-IRIS: clinical and pathological features.Journal of neurovirology · 2020Article
- Host-Immune Interactions in JC Virus Reactivation and Development of Progressive Multifocal Leukoencephalopathy (PML).Journal of neuroimmune pharmacology : the official journal of the Society on NeuroImmune Pharmacology · 2019Review
- Treatment of natalizumab-associated PML with filgrastim.Annals of clinical and translational neurology · 2019Article
- Current and Emerging Therapies in Multiple Sclerosis: Implications for the Radiologist, Part 2-Surveillance for Treatment Complications and Disease Progression.AJNR. American journal of neuroradiology · 2017Review
- Neurological safety of fingolimod: An updated review.Clinical & experimental neuroimmunology · 2017Review
- Multiple sclerosis update: use of MRI for early diagnosis, disease monitoring and assessment of treatment related complications.The British journal of radiology · 2017Review
- Article
- Drug-associated progressive multifocal leukoencephalopathy: a clinical, radiological, and cerebrospinal fluid analysis of 326 cases.Journal of neurology · 2016Article
- Natalizumab-Related Progressive Multifocal Leukoencephalopathy-Immune Reconstitution Inflammatory Syndrome: A Case Report Highlighting Clinical and MRI Features.The Malaysian journal of medical sciences : MJMS · 2016Article
- Predictors and characteristics of seizures in survivors of progressive multifocal leukoencephalopathy.Journal of neurovirology · 2016Article
- Stratification and monitoring of natalizumab-associated progressive multifocal leukoencephalopathy risk: recommendations from an expert group.Journal of neurology, neurosurgery, and psychiatry · 2016Review
- Progressive Multifocal Leukoencephalopathy in a Multiple Sclerosis Patient Diagnosed after Switching from Natalizumab to Fingolimod.Case reports in neurological medicine · 2016Article
- Immunotherapies for Neurological Manifestations in the Context of Systemic Autoimmunity.Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics · 2016Review
- Neurological immune reconstitution inflammatory response: riding the tide of immune recovery.Current opinion in neurology · 2015Review
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6 authors at 1 institution in 1 country.
Funding
Abstract
objectiveProgressive multifocal leukoencephalopathy (PML) is a severe complication of natalizumab therapy in patients with multiple sclerosis (MS), which is often accompanied by an immune reconstitution inflammatory syndrome (IRIS) after removal of the drug. We describe a patient with MS who presented with simultaneous PML-IRIS 2 months after stopping natalizumab for other reasons. CASE REPORT AND
resultsThe patient had widespread PML and severe IRIS. He received corticosteroids and displayed a vigorous JC virus-specific cellular immune response. Elevated myoinositol and lipid/creatine peaks measured in PML lesions by proton magnetic resonance spectroscopy ((1)H-MRS) corresponded to episodes of contrast enhancement on MRI scans and persisted after the enhancement subsided. He demonstrated steady clinical improvement, but developed marked residual atrophy in areas affected by PML and inflammation, as well as seizures.
conclusionsNew enhancing white matter lesions, occurring after discontinuation of natalizumab, can be the manifestation of PML-IRIS rather than an MS exacerbation. Elevated myoinositol and lipid/creatine peaks appear to be more sensitive markers of inflammation in PML lesions than contrast enhancement. (1)H-MRS may become useful as a biomarker for PML-IRIS by helping clinicians determine the need for corticosteroid administration and anticipate continuing clinical recovery.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.