Natalizumab for multiple sclerosis

A 30-year-old woman was evaluated for consideration of treatment options for multiple sclerosis. Two years earlier she had reported having vertigo. The diagnosis of multiple sclerosis was confirmed by clinical evaluation, examination of cerebrospinal fluid, and magnetic resonance imaging (MRI). Injections with interferon beta had been discontinued because of worsening depression (which had preceded the onset of multiple sclerosis). Despite treatment with glatiramer acetate injections and bimonthly intravenous administration of methylprednisolone, she had three episodes of acute neurologic deterioration, with motor and cerebellar involvement, and incomplete recovery between the attacks. Neurologic examination showed mild ocular and limb dysmetria, weakness of the right side, and sensory loss below the midthorax. She was referred to a multiple sclerosis center for possible treatment with natalizumab. Copyright © 2007 Massachusetts Medical Society.