Different MRI patterns in MS worsening after stopping fingolimod

Caterina Lapucci, Damiano Baroncini, Maria Cellerino, Giacomo Boffa, Ilaria Callegari, Matteo Pardini, Giovanni Novi, Maria Pia Sormani, Giovanni Luigi Mancardi, Angelo Ghezzi, Mauro Zaffaroni, Antonio Uccelli, Matilde Inglese, Luca Roccatagliata

Research output: Contribution to journalArticlepeer-review


ObjectiveTo analyze MRI images in patients with MS who experienced worsening of neurologic status (WNS) after stopping fingolimod (FTY).MethodsIn this retrospective study, demographic, clinical, and radiologic data of patients with MS who experienced WNS after stopping FTY were retrospectively collected. We introduced the "δExpanded Disability Status Scale (EDSS)-ratio" to identify patients who, after FTY withdrawal, showed an inflammatory flare-up exceeding the highest lifetime disease activity level. Patients with δEDSS-ratio > 1 were enrolled in the study.ResultsEight patients were identified. The mean (SD) age of the 8 (7 female) patients was 35.3 (4.9) years. The mean FTY treatment duration was 3.1 (0.8) years. The mean FTY discontinuation-WNS interval was 4 (0.9) months. The 4 patients with δEDSS-ratio ≥ 2 developed severe monophasic WNS (EDSS score above 8.5), characterized by clinical features and MRI findings not typical of MS, which we classified as "tumefactive demyelination pattern" (TDL) and "Punctuated pattern" (PL). Conversely, patients whose δEDSS-ratio was between 1 and 2 had clinical features and brain MRI compatible with a more typical, even if aggressive, MS relapse. In patients with TDL and PL, the flare-up of inflammatory activity led to severe tissue damage resulting in T2 but also T1 lesion volume increase at 6-month follow-up.ConclusionsPeculiar MRI features (TDL and PL), different from a typical MS flare-up, might occur in some patients who experienced WNS after stopping FTY. Further studies, also involving immunologic biomarkers, are necessary to investigate TDL or PL pathophysiology.

Original languageEnglish
Article numbere566
JournalNeurology: Neuroimmunology and NeuroInflammation
Issue number4
Publication statusPublished - Jul 1 2019

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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