Highlights SSPE diagnosis can be missed in adult cases if not included in the differential diagnosis. Adult cases may present with atypical clinical features and with an aggressive course. Antiviral drugs and immunomodulatory modalities have been tried alone or in combination, but there is no cure for SSPE. Measles vaccination is the only measure that can reduce the risk of SSPE.

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Background/aim Disease-modifying treatments (DMT) are used to prevent future relapses and disability. High long-term adherence to treatment is important to achieve disease control. This study aims to investigate and compare adherence, adverse event (AE) profiles, and frequencies, main reasons for treatment discontinuation under Teriflunomide (TERI), Dimethyl Fumarate (DMF), and Fingolimod (FNG) for relapsing-remitting MS (RRMS) patients. This study is designed to explore patient-reported experiences in real-life settings. Materials and methods Patients who were older than 18 years with a definite diagnosis of RRMS and no history of stem-cell transplantation were included. Outpatient clinic data files at the Neurology Department of Marmara University from June 2012 to June 2019 were examined retrospectively. Results One hundred and ninety MS patients were enrolled. 118 FNG, 51 DMF, 44 TERI treatment cycles were recorded. Time since disease onset, time since diagnosis, and treatment duration were significantly longer for FNG (p = 0.012, p = 0.004, p < 0.001). 72.8% of all the treatment cycles were continued. There was no significant difference in treatment continuity between the 3 DMT groups. The most common reasons for treatment discontinuation in order of frequency were adverse events, the progression of the disease, and the persistence of relapses. No significant difference was found for treatment discontinuation reasons. 32% of the patients reported at least one AE. 28% FNG, 49 % DMF, and 27.3% TERI using patients reported AEs. AEs were much more frequently reported for DMF (p = 0.015). The most common adverse events for each DMT were alopecia (n = 6, 13.6%) for TERI, flushing for DMF (n = 20, 39.2%), and persistent lymphopenia for FNG (n = 9, 7.6%). No severe or life-threatening AE was reported for DMF, one patient experienced pancreatitis under TERI, and 11 (9.3%) patients using FNG had to stop treatment due to serious or life-threatening AEs including cardiac adverse events, opportunistic infections, and dysplasia. Conclusion Overall treatment discontinuation because of AEs is as low as 10.3% in this study. However, AEs are still the main reason for treatment drop-out.

Introduction'Immune checkpoint inhibitors' are used in patients with metastatic malignant melanoma. Programmed cell death-1 (PD-1) and cytotoxic lymphocyte-associated protein 4 (CTLA-4) are found on the surface of T cells and are used as targets for the formation of an immune response against the tumor. Anti-CTLA-4 antibody ipilimumab and anti-PD-1 antibodies nivolumab and pembrolizumab are used as treatment options in patients with advanced melanoma. However, immune-related adverse events (irAEs) occur in approximately 40% of patients. Neurological side effects are rare. CaseIpilimumab and nivolumab combination therapy was applied in a 60-year-old male patient due to malignant melanoma after detection of metastasis after pembrolizumab, another immune checkpoint inhibitor. After the last course of treatment, numbness in the legs, loss of strength and inability to walk developed. Neurological examination revealed 5-/5 muscle strength of all upper extremity muscle groups, 1/5 muscle strength in the lower extremities, and loss of sensation in the lower extremities that did not give a clear level. In spinal imaging, the longitudinal, diffuse edematous image extending from the upper cervical to the lower thoracic levels was evaluated as transverse myelitis. Human Herpes Virus-7 (HHV-7) DNA detected in cerebrospinal uid (CSF) could not be demonstrated in serum. A second CSF examination could not be performed regarding the role of HHV-7 in the etiology. ConclusionIn conclusion, patients given immune checkpoint inhibitors should be followed up for signs and symptoms of irAE. Prompt diagnosis and treatment will increase the likelihood of complete recovery from neurological complications.

Introduction'Immune checkpoint inhibitors' are used in patients with metastatic malignant melanoma. Programmed cell death-1 (PD-1) and cytotoxic lymphocyte-associated protein 4 (CTLA-4) are found on the surface of T cells and are used as targets for the formation of an immune response against the tumor. Anti-CTLA-4 antibody ipilimumab and anti-PD-1 antibodies nivolumab and pembrolizumab are used as treatment options in patients with advanced melanoma. However, immune-related adverse events (irAEs) occur in approximately 40% of patients. Neurological side effects are rare.CaseIpilimumab and nivolumab combination therapy was applied in a 60-year-old male patient due to malignant melanoma after detection of metastasis after pembrolizumab, another immune checkpoint inhibitor. After the last course of treatment, numbness in the legs, loss of strength and inability to walk developed. Neurological examination revealed 5-/5 muscle strength of all upper extremity muscle groups, 1/5 muscle strength in the lower extremities, and loss of sensation in the lower extremities that did not give a clear level. In spinal imaging, the longitudinal, diffuse edematous image extending from the upper cervical to the lower thoracic levels was evaluated as transverse myelitis. Human Herpes Virus-7 (HHV-7) DNA detected in cerebrospinal fluid (CSF) could not be demonstrated in serum. A second CSF examination could not be performed regarding the role of HHV-7 in the etiology.ConclusionIn conclusion, patients given immune checkpoint inhibitors should be followed up for signs and symptoms of irAE. Prompt diagnosis and treatment will increase the likelihood of complete recovery from neurological complications.