Epub ahead of print:
Talab R. Marburg Variant Multiple Sclerosis - a case report. Neuro Endocrinol Lett. 2011 Aug 30;32(4).
In this case the investigators describe a 24 year-old female with a fulminant demyelinating disease of white matter. Disease progression was consistent with the Marburg variant (malignant form) of MS with rapid deterioration of her clinical condition and epileptic seizures; ending with persistent coma and tetraparesis (weakness in all 4 limbs), over the course of 6 months from first symptoms. Repeated MRI showed progression of multiple demyelinating lesions culminating in a contiguous focal disorder of the white matter extending through out the brain. The serial MRI changes closely mapped the deterioration in the patients clinical status. Unfortunately the patient did not respond to repeated pulses of steroids, administration of intravenous immunoglobulins, serial plasmapheresis and high-dose immunosuppression (including mitoxantrone).
"Why have I highlighted another case of malignant MS on this blog? No, it is not to depress you. Firstly, fulminant MS is rare, hence individual case reports. Secondly, most clinicians feel compelled to write these cases up in the hope that other neurologists can learn from them. Thirdly, the real value of publishing individual case studies exists in the future when someone will almost certainly pull all these cases together in a meta-analysis. This is how a lot of diseases become recognised and established."
"I am great supporter of the case study, provided it has something to teach the reader."
"What does this case study teach us? That not all MS is necessarily amenable to treatment.
"If I was looking after this case I would have considered using Rituximab (anti-CD20), which targets B cells, and Natalizumab, a selective adhesion molecule inhibitor that blocks trafficking of lymphocytes in the brain and spinal cord."
Related posts of interest on this blog:
26 Aug 2011
Fulminant MS can be accompanied by optic neuritis (ON); however a long interval between ON and the fulminant phase has not been reported. This is a case report of 30-year-old woman with a history of ON that occurred 1 ...
27 Aug 2011
The term fulminant is a carry-over from the pre disease-modifying therapy era. Most cases presenting with Marburg's variant of MS who treated promptly with appropriate therapies, respond to treatment, and can do very well. ...