Universität zu Köln

Wattjes, Mike P., Wijburg, Martijn T., van Eijk, Jeroen, Frequin, Stephan, Uitdehaag, Bernard M. J., Barkhof, Frederik ORCID: 0000-0003-3543-3706, Warnke, Clemens and Killestein, Joep (2018). Inflammatory natalizumab-associated PML: baseline characteristics, lesion evolution and relation with PML-IRIS. J. Neurol. Neurosurg. Psychiatry, 89 (5). S. 535 - 542. LONDON: BMJ PUBLISHING GROUP. ISSN 1468-330X

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Abstract

Background and objective Natalizumab-associated progressive multifocal leukoencephalopathy (NTZ-PML) patients may show imaging signs suggestive of inflammation at diagnosis ('inflammatory PML'), reminiscent of PML-immune reconstitution inflammatory syndrome (PML-IRIS). We investigated the imaging characteristics of inflammatory NTZ-PML lesions and PML-IRIS to determine differentiating and overlapping features. Methods We scored the presence, localisation and pattern of imaging characteristics of inflammation on brain MRI scans of inflammatory NTZ-PML patients. The imaging characteristics were followed up until the occurrence of PML-IRIS. Results Ten out of the 44 NTZ-PML patients included showed signs suggestive of inflammation at the time of diagnosis. The inflammation pattern at diagnosis was similar to the pattern seen at PML-IRIS, with contrast enhancement representing the most frequent sign of inflammation (90% at diagnosis, 100% at PML-IRIS). However, the severity of inflammation differed, with absence of swelling and low frequency of perilesional oedema (10%) at diagnosis, as compared with the PML-IRIS stage (40%). Conclusion Patterns of inflammation at the time of PML diagnosis and at the PML-IRIS stage overlap but differ in their severity of inflammation. This supports histopathological evidence that the inflammation seen at both stages of the same disease shares a similar underlying pathophysiology, representing the immune response to the JC virus to a variable extend.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Wattjes, Mike P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wijburg, Martijn T. UNSPECIFIED UNSPECIFIED UNSPECIFIED van Eijk, Jeroen UNSPECIFIED UNSPECIFIED UNSPECIFIED Frequin, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Uitdehaag, Bernard M. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Barkhof, Frederik UNSPECIFIED orcid.org/0000-0003-3543-3706 UNSPECIFIED Warnke, Clemens UNSPECIFIED UNSPECIFIED UNSPECIFIED Killestein, Joep UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-188601
DOI:	10.1136/jnnp-2017-316886
Journal or Publication Title:	J. Neurol. Neurosurg. Psychiatry
Volume:	89
Number:	5
Page Range:	S. 535 - 542
Date:	2018
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	1468-330X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY; TREATED MS PATIENTS; MULTIPLE-SCLEROSIS; IMAGING CHARACTERISTICS; MRI; DISEASE; PATTERN; DIAGNOSIS; RECOMMENDATIONS; GUIDELINES Multiple languages Clinical Neurology; Psychiatry; Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/18860