Universität zu Köln

Wijburg, Martijn T., Warnke, Clemens, Barkhof, Frederik ORCID: 0000-0003-3543-3706, Uitdehaag, Bernard M. J., Killestein, Joep and Wattjes, Mike P. (2019). Performance of PML diagnostic criteria in natalizumab-associated PML: data from the Dutch-Belgian cohort. J. Neurol. Neurosurg. Psychiatry, 90 (1). S. 44 - 47. LONDON: BMJ PUBLISHING GROUP. ISSN 1468-330X

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Abstract

Objective To test the current progressive multifocal leukoencephalopathy (PML) diagnostic criteria by applying them to patients previously diagnosed with natalizumab (NTZ)-associated PML in a real-world clinical setting. Methods Patients from the Dutch-Belgian NTZ-PML cohort (n=28) were reviewed at the time of first diagnostic work-up and during follow-up, using the PML diagnostic criteria as proposed in a consensus statement from the American Academy of Neurology. Results At first diagnostic work-up, 18 patients (64.3%) met the criteria for high diagnostic certainty for PML ('definite PML' or 'probable PML'). During follow-up, this increased to 20 patients (71.4%) as JC virus DNA was detected in cerebrospinal fluid of two additional patients. Nonetheless, 28.6% of patients were still classified as 'possible PML' or 'not PML' (6 (21.5%) and 2 (7.1%) patients, respectively) despite a very high suspicion for PML based on lesion evolution and signs of PML-immune reconstitution inflammatory syndrome on MRI, and development of compatible symptoms. Conclusions The current case definition of PML has low sensitivity for diagnosis of NTZ-PML in a real-world clinical setting in which MRI is frequently used for PML screening. This may delay diagnosis and appropriate management of PML, and may complicate a valid estimation of PML incidence during NTZ therapy.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Wijburg, Martijn T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Warnke, Clemens UNSPECIFIED UNSPECIFIED UNSPECIFIED Barkhof, Frederik UNSPECIFIED orcid.org/0000-0003-3543-3706 UNSPECIFIED Uitdehaag, Bernard M. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Killestein, Joep UNSPECIFIED UNSPECIFIED UNSPECIFIED Wattjes, Mike P. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-139646
DOI:	10.1136/jnnp-2018-318261
Journal or Publication Title:	J. Neurol. Neurosurg. Psychiatry
Volume:	90
Number:	1
Page Range:	S. 44 - 47
Date:	2019
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; ASYMPTOMATIC PML; PATTERN Multiple languages Clinical Neurology; Psychiatry; Surgery Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/13964