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Refractory epilepsy following natalizumab associated PML
Tarig Mohammed Abkur1, Hugh Kearney1, Michael J Hennessy1
1Department of Neurology, Galway University Hospital, Galway, Ireland.
Multiple Sclerosis and Related Disorders
|December 19, 2017
Summary
Natalizumab for multiple sclerosis can cause progressive multifocal leukoencephalopathy (PML). This case highlights that epilepsy may be a long-term complication of PML, potentially due to brain tissue involvement.
Area of Science:
- Neuroimmunology
- Infectious Neurology
Background:
- Natalizumab is an effective treatment for multiple sclerosis (MS).
- Natalizumab therapy carries a risk of progressive multifocal leukoencephalopathy (PML), a serious opportunistic infection caused by John Cunningham virus (JCV) reactivation.
- PML is a demyelinating disease affecting the central nervous system.
Observation:
- A 40-year-old woman developed refractory temporal lobe epilepsy.
- This epilepsy emerged one year after her recovery from Natalizumab-induced PML.
- The epilepsy was localized and treatment-resistant.
Findings:
- Refractory epilepsy can be a chronic, disabling complication following PML.
- Epilepsy in the context of PML likely indicates grey matter involvement.
- Involved grey matter may serve as a cortical epileptogenic zone, leading to seizures.
Implications:
- This case underscores the potential for long-term neurological sequelae after PML.
- Clinicians should consider epilepsy as a possible complication in patients with a history of PML.
- Further research is needed to understand the mechanisms and management of PML-related epilepsy.
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