Author Topic: (Abst.) [Early identification of PML in patients on Tysabri]  (Read 99 times)

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Offline agate

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(Abst.) [Early identification of PML in patients on Tysabri]
« on: August 03, 2015, 03:39:19 pm »
From PubMed via the MS International Federation News, July 27, 2015:

Quote
J Neurol Neurosurg Psychiatry. 2015 Jul;86(7):793-8.

MRI pattern in asymptomatic natalizumab-associated PML

Wattjes MP1, Vennegoor A2, Steenwijk MD1, de Vos M1, Killestein J2, van Oosten BW2, Mostert J3, Siepman DA4, Moll W5, van Golde AE6, Frequin ST7, Richert ND8, Barkhof F1.

Author information

1Department of Radiology and Nuclear Medicine, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
2Department of Neurology, MS Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
3Department of Neurology, Rijnstate Hospital, Arnhem, The Netherlands.
4Department of Neurology, Erasmus MC, University Medical Center Rotterdam, MS Center, Rotterdam, The Netherlands.
5Department of Neurology, Maasstad Hospital, Rotterdam, The Netherlands.
6Department of Neurology, GT Hospital Almelo, Almelo, The Netherlands.
7Department of Neurology, St. Antonius Hospital, Nieuwegein, The Netherlands.
8Multiple Sclerosis Clinical Development Group, Biogen Idec, Cambridge, Massachusetts, USA.

OBJECTIVE:

To investigate the MRI manifestation pattern of asymptomatic natalizumab-associated progressive multifocal leukoencephalopathy (PML) in patients with multiple sclerosis (MS).

METHODS:

18 patients with MS with natalizumab-associated PML lesions on MRI were included. In 6 patients, the PML lesions were identified on MRI prospectively and in 12 patients PML lesions were identified retrospectively. MRI sequences were analysed for PML lesion distribution, appearance, grey matter/white matter involvement and possible signs of inflammation. Lesion probability maps were created to demonstrate lesion distribution pattern.

RESULTS:

The frontal lobe was involved in 14 patients (77.8%) and the parietal lobe in 4 patients (22.2%). Most patients presented with focal lesions (13 patients, 72.2%) involving one single lobe (12 patients, 66.7%). The cortical grey matter was affected in 15 patients (83.3%) and 13 patients (72.2%) presented with a combination of cortical grey and white matter involvement. Signs of inflammation were detected in 7 patients (38.8%). Among patients with available diffusion-weighted imaging, 6 patients (40%) did not show high-signal-intensity lesions. A classical imaging pattern including unilateral and unilobar focal lesions in the frontal lobe affecting the cortical grey matter or the cortical grey and adjacent white matter was observed in 8 patients (44.4%).

CONCLUSIONS:

Asymptomatic natalizumab-associated PML manifestations on MRI show a rather localised disease, frequently located in the frontal lobes, affecting the cortical grey matter and adjacent juxtacortical white matter. Awareness of this lesion pattern facilitates an earlier diagnosis of natalizumab-associated PML in an asymptomatic stage associated with a more favourable prognosis.
 

The abstract can be seen here.
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