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Updated: May 13, 2026
09:41
Comprehensive Autopsy Program for Individuals with Multiple Sclerosis
Published on: July 19, 2019
Progressive multifocal leukoencephalopathy in patients with multiple sclerosis
Kelly J Baldwin1, Jeffery P Hogg
1Department of Neurology, West Virginia University School of Medicine, Morgantown, West Virginia, USA. kbaldwin@hsc.wvu.edu
Current Opinion in Neurology
|March 16, 2013
Summary
Progressive multifocal leukoencephalopathy (PML) is a rare infection linked to natalizumab treatment for multiple sclerosis. Risk stratification, early diagnosis, and treatment can mitigate this risk.
Area of Science:
- Neuroimmunology
- Infectious Diseases
- Neurology
Background:
- Progressive multifocal leukoencephalopathy (PML) is a rare opportunistic central nervous system infection.
- PML is associated with selective immunosuppression, particularly in multiple sclerosis (MS) patients.
- Natalizumab, a treatment for MS, has been linked to an increased risk of PML.
Purpose of the Study:
- To review the pathogenesis, clinical presentation, diagnosis, and treatment of natalizumab-associated PML.
- To highlight advances in understanding and managing this rare complication.
- To inform clinicians on risk stratification and diagnostic strategies.
Main Methods:
- Literature review focusing on natalizumab-associated PML.
- Analysis of diagnostic challenges and advancements.
- Discussion of treatment strategies and risk mitigation.
Main Results:
- Risk stratification tools, including JC-virus antibody status, prior immunosuppression, and treatment duration, can help minimize PML risk.
- Diagnosis of natalizumab-associated PML presents challenges but is aided by unique clinical features, sensitive lab tests, and advanced MRI.
- Despite advances in MS treatment, PML remains an unintended risk.
Conclusions:
- Significant gaps remain in understanding PML pathogenesis and its link to therapeutic immunosuppression.
- Natalizumab-associated PML is rare compared to MS-related disability.
- Risk mitigation is possible through appropriate patient selection, accurate diagnosis, and aggressive treatment.
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