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Natalizumab, an effective treatment for MS, has been shown to exacerbate neuromyelitis optica (NMO) with aquaporin-4 antibodies, but whether this is the case in antibody negative NMO and atypical MS/NMO spectrum disorder overlap syndromes is unknown. We describe a patient with a relapsing optico-spinal demyelinating syndrome, negative for aquaporin-4 antibodies, who experienced a catastrophic brain relapse shortly after a single dose of natalizumab, highlighting that MS immunomodulatory drugs may worsen demyelination in patients with seronegative NMO and atypical MS/NMO overlap syndromes even if they are aquaporin-4 antibody negative. We summarise the treatments considered safe and effective in NMO, and those with potential to exacerbate disease.

Original publication

DOI

10.1016/j.jns.2014.01.035

Type

Journal article

Journal

J Neurol Sci

Publication Date

15/04/2014

Volume

339

Pages

223 - 225

Keywords

AQP4, Aquaporin-4, Devic's disease, NMO, Natalizumab, Neuromyelitis optica, Adult, Antibodies, Monoclonal, Humanized, Brain, Catastrophic Illness, Female, Humans, Integrin alpha4, Natalizumab, Neuromyelitis Optica