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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
PubMed
Abstract

Insights

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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