TY - T1的优秀结果Natalizumab-Associated PML由于早期诊断和最佳治疗(P2.249) JF -神经学乔-神经学六世- 82 - 10补充SP - P2.249 AU - Georg Pilz AU -安德里亚勒AU首页 -彼得Wipfler盟凯特琳Oppermann AU -约翰·Sellner盟Shahrzad Afazel AU -伊丽莎白Haschke-Becher盟-沃尔Rispens盟迪泽van der Kleij AU -尤金Trinka盟Jorg克劳斯Y1 - 2014/04/08 UR - //www.ez-admanager.com/content/82/10_Supplement/P2.249.abstract N2 -目的:强调早期诊断和正确治疗的重要性,一个好的结果在MS患者Natalizumab-Associated PML。背景:PML natalizumab治疗期间是一种罕见但严重的并发症。由于其功效natalizumab仍然是一个重要的治疗选择患者的风险增加发展中PML。设计/方法:病例报告结果:我们报告一个43岁男性JCV血清反应阳性的病人女士自2007年以来natalizumab治疗。步态障碍的增加02/2013是我们医院录取的原因。MRI显示非典型小脑的病变。JCV DNA的检测脑脊液PCR导致natalizumab-associated PML的诊断。免疫表型出现显示典型的倒生的CD4 / CD8 T细胞比例的CSF反光natalizumab背后的血脑屏障的影响。串行血浆置换(丛)进行加速免疫重建。Natalizumab稀释的淋巴细胞进行流式细胞术。8个周期足够natalizumab丛是必要的间隙从血液中也证实了ELISA。 MRI six days after the last PLEX was indicative of an incipient IRIS. CSF showed a slight pleocytosis, normalized CD4/CD8 T cell ratio and very low residual levels of free natalizumab indicating that the blocking effect of natalizumab was abrogated. IRIS was treated with high dose methylprednisolone. The patient was clincially stable during the entire period and the initial gait disturbance diminished after a few weeks. CONCLUSIONS: The most important factors for a good outcome of natalizumab-associated PML are early diagnosis, immediate immune reconstitution, and control of IRIS. They depend on thight clinical patient surveillance, sufficient PLEX treatment and an early counter to IRIS. Serial flow cytometric analyses of blood and CSF has the potential to act as a treatment biomarker both for the effect of PLEX and also for the initiation of IRIS. :Disclosure: Dr. Pilz has nothing to disclose. Dr. Harrer has received personal compensation for activities with Merck Serono. Dr. Wipfler has received personal compensation for activities with Merck Serono, Bayer Pharmaceuticals Corp., Novartis, and Biogen Idec. Dr. Oppermann has received personal compensation for activities with Merck & Co. Inc., and Sanofi-Aventis Pharmaceuticals Inc. as an attendee at scientific meetings. Dr. Sellner has received personal compensation for activities with Biogen Idec, Terumo, Tatiopharm, and Merck Serono. Dr. Afazel has nothing to disclose. Dr. Haschke has received research support from Abbott Diagnostics, and Roche Diagnostics Corp. Dr. Rispens has nothing to disclose. Dr. van der Kleij has nothing to disclose. Dr. Trinka has received personal compensation for activities with UCB Pharma, Biogen Idec, Gerot-Lannacher, Bial, and Eisai Inc. Dr. Trinka has received research support from Biogen Idec, Novartis, and Bayer Pharmaceuticals Corp. Dr. Kraus has received personal compensation for activities with Allmirall, Bayer Pharmaceuticals Corp., Biogen Idec, Genzyme Corp., Medtronic Inc., Merck Serono, Novartis, and Sanofi-Avent Pharmaceuticals Inc.Tuesday, April 29 2014, 7:30 am-11:00 am ER -