Contributions
Abstract: EP1375
Type: ePoster
Abstract Category: Clinical aspects of MS - MS and gender
Natalizumab is used to treat highly-active relapsing-remitting multiple sclerosis. It is discontinued in certain clinical situations such as progressive multifocal leucoencephalopathy (PML) and pregnancy. Here we describe a case of cerebral and cervical cord immune reconstitution inflammatory syndrome (IRIS) causing florid CNS inflammation and life-threatening disability in a pregnant patient after discontinuation of natalizumab. The patient was virtually symptom free prior to pregnancy but became quadriparetic, encephalopathic, hypertonic, and grossly ataxic after stopping natalizumab following conception. She required 24 hour inpatient nursing care. After minimal response to steroids, dramatic clinical rescue was achieved by re-starting natalizumab during pregnancy and accepting a small risk to the foetus. The patient gave birth to a healthy baby girl some months later, and has made a virtually complete recovery. This difficult case highlights many of the dilemmas facing MS Neurologists as new, effective disease-modifying therapies come to clinic without the longitudinal data to guide decision-making. The risks and potential benefits of suspending therapy in pregnancy are discussed.
Disclosure: Tom Massey has received support from Novartis to attend a scientific meeting.
Owen Pearson has received honoraria and support to attend scientific meetings, speakers" fees, and advisory boards from Biogen, Genzyme, Novartis, Teva, Merck Serono and Roche.
Abstract: EP1375
Type: ePoster
Abstract Category: Clinical aspects of MS - MS and gender
Natalizumab is used to treat highly-active relapsing-remitting multiple sclerosis. It is discontinued in certain clinical situations such as progressive multifocal leucoencephalopathy (PML) and pregnancy. Here we describe a case of cerebral and cervical cord immune reconstitution inflammatory syndrome (IRIS) causing florid CNS inflammation and life-threatening disability in a pregnant patient after discontinuation of natalizumab. The patient was virtually symptom free prior to pregnancy but became quadriparetic, encephalopathic, hypertonic, and grossly ataxic after stopping natalizumab following conception. She required 24 hour inpatient nursing care. After minimal response to steroids, dramatic clinical rescue was achieved by re-starting natalizumab during pregnancy and accepting a small risk to the foetus. The patient gave birth to a healthy baby girl some months later, and has made a virtually complete recovery. This difficult case highlights many of the dilemmas facing MS Neurologists as new, effective disease-modifying therapies come to clinic without the longitudinal data to guide decision-making. The risks and potential benefits of suspending therapy in pregnancy are discussed.
Disclosure: Tom Massey has received support from Novartis to attend a scientific meeting.
Owen Pearson has received honoraria and support to attend scientific meetings, speakers" fees, and advisory boards from Biogen, Genzyme, Novartis, Teva, Merck Serono and Roche.