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Review of progressive multifocal leukoencephalopathy and natalizumab

Allen J Aksamit1

  • 1Mayo Clinic College of Medicine, Department of Neurology, Rochester, Minnesota 55905, USA. aksamit@mayo.edu

The Neurologist
|November 24, 2006
PubMed
Abstract

Insights

Progressive multifocal leukoencephalopathy (PML) is a risk for natalizumab users. Early detection of PML or JC virus is challenging, but natalizumab withdrawal may improve survival in multiple sclerosis patients.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Immunology

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a demyelinating infection affecting oligodendrocytes.
  • PML has been observed in patients undergoing natalizumab treatment.
  • Distinguishing PML from multiple sclerosis (MS) using MRI is difficult; JC virus detection in spinal fluid is specific but not always sensitive.

Purpose of the Study:

  • To evaluate the risk of PML in patients treated with natalizumab.
  • To identify potential methods for early detection and management of PML.
  • To inform risk-benefit assessments for natalizumab therapy in MS patients.

Main Methods:

  • Case review of natalizumab-treated patients.
  • Analysis of diagnostic challenges including MRI and JC virus detection.
  • Assessment of treatment outcomes and risk factors.

Main Results:

  • Natalalizumab is a predisposing factor for PML, with an estimated incidence of 1 in 1000.
  • No reliable presymptomatic surveillance methods for PML or JC virus infection exist.
  • Duration of natalizumab treatment may be an independent risk factor.
  • One patient survived after natalizumab withdrawal and potential antiviral therapy, though immune reconstitution disease is a risk.

Conclusions:

  • PML is a significant risk associated with natalizumab use and should be considered.
  • Treatment of MS with natalizumab involves informed, individualized risk assessment.
  • PML deficits are likely permanent, emphasizing the need for careful patient selection and monitoring.

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