Natalizumab
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Natalizumab Rebound effect in the form of spastic paralysis, gait ataxia and plegia: case report
A 33-year-old woman developed rebound effect in the form of spastic paralysis, gait ataxia and plegia following discontinuation of natalizumab, given for the treatment of relapsing-remitting multiple sclerosis (RRMS) [route and dose not stated]. The woman, who had RRMS, was treated with natalizumab for 5 years. Due to her desire for pregnancy, the treatment with natalizumab was discontinued. After a month, she got pregnant on purpose. Thereafter, at 14 weeks of gestation, she developed spastic paralysis of lower limbs and gait ataxia. The expanded disability status scale (EDSS) score was 6.5. Subsequently, a brain MRI showed increased T2 lesions. Therefore, the woman was treated with IV methylprednisolone for 5 days with partial recovery. At 16 weeks of gestation, her symptoms deteriorated. She was admitted. After admission, she was found to have bilateral lower limbs and left arm plegia with an EDSS score of 8. The second brain MRI scan revealed increase of the number of T2 lesions, some of them with pseudotumoral form an openring gadolinium enhacement. Therefore, she was treated with methylprednisolone for 5 days with subsequent one cycle of therapeutic plasma exchange (TPE), without improvement. Then, she received combination therapy with methylprednisolone 1 g/day and alternate-day single-volume plasma exchange prior to alternate-day dose of IV immune-globulin [immunoglobulin]. After these combination therapies, her symptoms improved with EDSS score of 6.5. At 18 weeks of gestation, she was restarted on natalizumab every 6 weeks. At 34 weeks of gestation, she presented with preterm premature rupture of membranes. Subsequently, she gave birth to a healthy baby. After 1 week of delivery, she received natalizumab. Gomez Estevez I, et al. Management of severe rebound of natalizumab during pregnancy. European Journal of Neurology 27 (Suppl. 1): 918-919, May 2020 [abstract]
0114-9954/20/1819-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
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Reactions 29 Aug 2020 No. 1819
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