DIR Return Create A Forum - Home
---------------------------------------------------------
MS Speaks
HTML https://msspeaks.createaforum.com
---------------------------------------------------------
*****************************************************
DIR Return to: TYSABRI (natalizumab)
*****************************************************
#Post#: 1688--------------------------------------------------
(AAN abst.) EEG findings and clinico-radiographic correlation in
Tysabri-associated PML
By: agate Date: May 17, 2017, 2:08 pm
---------------------------------------------------------
Presented at the annual AAN conference (Boston, April 2017):
[quote]EEG findings and clinico-radiographic correlation in
nataluzimab-associated
progressive multifocal leukoencephalopathy
Zehra Husain1, Roumen Balabanov2, Miral Jhaveri1, Fabian Sierra
Morales1, Igor Koralnik1, Adriana Bermeo Ovalle1
1
Rush University Medical Center, 2 Northwestern Memorial Hospital
Objective:
To describe the clinical, radiographic, and EEG features of
nataluzimab-associated progressive multifocal
leukoencephalopathy (nataluzimab-PML) patients with suspected
seizures.
Background:
Seizures are a known complication of nataluzimab-PML, especially
during immune reconstitution inflammatory syndrome (IRIS).
However, specific EEG findings have not been described or
correlated with clinical/radiographic data.
Design/Methods:
We retrospectively analyzed patients diagnosed with
nataluzimab-PML at a tertiary referral center from 2010-2015. We
evaluated EEGs performed during suspected seizures and reviewed
concurrent MRIs with a senior neuroradiologist. EEG findings
were compared to MRI abnormalities and descriptions of clinical
events.
Results:
12/14 (85.7%) patients were female; mean age of nataluzimab-PML
onset was 43.9.
Though 11/14 received seizure prophylaxis, 9/14 (64.3%)
underwent EEGs for suspected seizures during IRIS: 7/9 (77.8%)
focal motor, 5 (55.6%) isolated altered mental status (AMS), 3
(33.3%) dyscognitive/automotor.
Interictal electrographic activity comprised 6 (66.7%) with a
combination of focal fast and rhythmic slow (FFRS), 6 (66.7%)
intermittent irregular regional slowing, 5 (55.6%) intermittent
bifrontal delta, 4 (44.4%) PLED/PREDs, 2 (22.2%) intermittent
temporal rhythmic theta. Only 1 (11.1%) featured independent
regional epileptiform discharges. Ictal patterns included 4
(44.4%) regional repetitive rhythmic spiking, 2 (22.2%) evolving
regional rhythmic activity, 1 (11.1%) ictal intermittent
regional rhythmic delta activity. All MRIs demonstrated
restricted diffusion, with 6 (66.7%)
new/increasing T2/FLAIR hyperintensities, 4 (44.4%) enhancement,
4 (44.4%) hyperintense cortical signal (HCS).
3/9 had pre-seizure HCS. Co-localization of MRI to epileptiform
activity was 72.2% for enhancement, 61.1% HCS, 52.6% FLAIR/DWI.
Conclusions:
Seizures were the most common presenting symptom of
nataluzimab-PML IRIS, despite prophylaxis. Isolated AMS was a
frequent presentation. EEG findings suggest regional coexistence
of subcortical pathology and cortical irritability. FFRS was the
most frequent epileptiform abnormality. Epileptiform activity
co-localized most
reliably with radiographic enhancement.
5/9 patients required chronic seizure treatment.
This data highlights the value of early EEG as a prospective
diagnostic tool for patients with nataluzimab-PML. [/quote]
*****************************************************