Careful profiling of inflammatory markers in cerebrospinal fluid (CSF) of multiple sclerosis patients, coupled with standard exams and scans, helps in understanding disease evolution and treatment response, a case report suggests.
The report “Increase of CSF inflammatory profile in a case of highly active multiple sclerosis” was published in the journal BMC Neurology.
Researchers detailed the case of a 31-year-old woman, diagnosed with RRMS in December 2006 and with a history of poor response to disease-modifying therapies. At her diagnosis, magnetic resonance imaging (MRI) scans revealed the presence of T2-weighted hyperintense lesions in certain brain regions; some of the lesions were positive for gadolinium, a contrast agent to enhance MRI images that identifies lesions in an inflammatory state.
The patient began treatment with Teva’s Copaxone (glatiramer acetate), but twice relapsed in 2008. New scans confirmed active disease, as shown by new T2 and gadolinium positive T1-lesions. She was switched to treatment with interferon (IFN) beta-1a, but the disease remained active, with two annual relapses and new brain lesions.
In May 2014, she began treatment with cyclophosphamide, which was maintained until March 2015, and then switched to Biogen’s Tecfidera (dimethyl fumarate). This, however, failed to reduce disease activity with her level of disability, as measured by the EDSS score, increasing from 2 to 4.5. Cognitive difficulties, especially in memory and attention, were confirmed in tests.
She started on Lemtrada (alemtuzumab), by Sanofi-Genzyme, in June 2016. At her last follow-up in December 2017, she had no signs of disease activity and reported no treatment-related adverse effects. She had resumed most of her usual activities.
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