2021
DOI: 10.1186/s12883-021-02165-0
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Possible progressive multifocal leukoencephalopathy and active multiple sclerosis under dimethyl fumarate: the central role of MRI in informing therapeutic decisions

Abstract: Background Progressive multifocal leukoencephalopathy (PML) can rarely occur in Multiple Sclerosis (MS) patients undergoing dimethyl fumarate (DMF) treatment. Our case stresses the limits of current diagnostic and stratification risk criteria, highlighting the potential role of Magnetic Resonance Imaging (MRI) in advising clinical choices. Case presentation A 54 years old MS male patient treated with DMF, after 3 years of clinical stability develop… Show more

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Cited by 7 publications
(6 citation statements)
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“… 65 , 97 , 99 , 100 Age ⩾50 years is another risk factor for PML; however, neither age ⩾50 years nor severe prolonged lymphopenia are absolute identifiers of those at increased risk of PML, with recorded case reports in patients without these characteristics. 95 , 101 103 …”
Section: Resultsmentioning
confidence: 99%
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“… 65 , 97 , 99 , 100 Age ⩾50 years is another risk factor for PML; however, neither age ⩾50 years nor severe prolonged lymphopenia are absolute identifiers of those at increased risk of PML, with recorded case reports in patients without these characteristics. 95 , 101 103 …”
Section: Resultsmentioning
confidence: 99%
“…65,97,99,100 Age ⩾50 years is another risk factor for PML; however, neither age ⩾50 years nor severe prolonged lymphopenia are absolute identifiers of those at increased risk of PML, with recorded case reports in patients without these characteristics. 95,[101][102][103] Closer monitoring of patients with a higher risk of PML is recommended. This includes monitoring for lymphopenia 23,29 and regular (every 6-12 months) MRI scans.…”
Section: Therapeutic Advances In Neurological Disordersmentioning
confidence: 99%
See 1 more Smart Citation
“…Over the years, MRI has become one of the most important diagnostic tools available to NRs and clinicians, also providing relevant insights about the pathophysiology of damage in MS and offering new possibilities to monitor disease progression and treatment response [12]. In light of the crucial role of MRI in clinical settings [13], expert guidelines have been produced to ensure that MRI protocols for evaluations of MS patients would include sequences adequate for the application of the ever-evolving MS diagnostic criteria and longitudinal monitoring of disease activity. Specifically, the MAGNIMS committee identifies mandatory and optional sequences.…”
Section: Discussionmentioning
confidence: 99%
“…There was a tendency towards an increased incidence of nasopharyngitis, urinary tract infection, upper respiratory tract infection, bronchitis, sinusitis, and gastroenteritis [ 81 , 82 ]. Nevertheless, DMF treatment has been recognized to confer an increased risk of developing PML, with 11 cases reported to date [ 90 ]. Of note, this appears to be independent of the development of severe lymphopenia [ 91 , 92 ].…”
Section: Immunotherapies In Neurologymentioning
confidence: 99%