Abstract Details

Title Seizures and Preventive Antiepileptic Treatment in Patients with Multiple Sclerosis and Natalizumab Associated Progressive Multifocal Leukoencephalopathy

Topic MS and Related Diseases

Presentation(s) P01 - (-)

Poster/Presentation
Number 186

Objective

Background BACKGROUND: Seizures occur in 20% of HIV associated progressive multifocal leukoencephalopathy patients and with unknown frequency NAT-PML.

Design/Methods DESIGN/METHODS: We reviewed medical records of 15 NAT-PML patients (9 female, 6 male, mean duration of MS 12 SD 6.4) years, mean number of natalizumab infusions 34 (SD 11.4)) referred to a German University Hospital.

Results RESULTS: Eight patients developed seizures during PML (53.3%). Six had grand mal, 3 simple partial motor and 2 psychomotor seizures at least once. Seven had series of seizures or status epilepticus, often refractory to antiepileptic treatment. Seizures occurred with a mean delay of 61 days (SD 41,5) after diagnosis of PML. Corresponding to seizure onset, gadolinium enhancement at MRI was detected in 5 patients, indicative for an immune reconstitution inflammatory syndrome (IRIS). Six patients received PAT treatment with levetiracetam (1000 - 1750 mg per day) without any side effects. Patients with and without seizures and with and without PAT did not differ in sex, mean age at diagnosis of NAT-PML, mean number of natalizumab infusions, immunosuppressive pretreatment and in administration of mefloquine (2-tailed Fishers Exact Test & 2-tailed Mann-Whitney Exact Test p>=0.09). Patients who received PAT (n(total)=6; n(seizure)=1) had significantly less seizures than those who did not (n(total)=9; n(seizure)=7) (2-tailed Fishers Exact Test p=0,04).

Conclusions CONCLUSIONS: Seizures seem to be more common in NAT-PML, than in other types of-PML. Seizures occurred most commonly 2 months after diagnosis of PML during IRIS. This may explain higher seizure frequency in NAT-PML. PAT decreased the incidence of seizures significantly. Although data are limited we propose that NAT-PML patients may receive PAT before development of IRIS. Larger datasets are needed.

Authors/Disclosures
Robert Hoepner PRESENTER	Robert Hoepner has nothing to disclose.
	No disclosure on file
	No disclosure on file
Barbara Brzosko	No disclosure on file
Andrew H. Chan, MD (Dept of Neurology, University of Bochum, St. Josef-Hospital)	No disclosure on file
Ingo Kleiter (Neurologische Universitaetsklinik Regensburg)	No disclosure on file
Ralf Gold, MD (Neurologische Universitaetsklinik)	Dr. Gold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen . Dr. Gold has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Gold has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Roche. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genzyme. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer Vital. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Eisai Pharamaceuticals. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Gold has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for SAGE Publishers. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Novartis. Dr. Gold has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Biogen. The institution of Dr. Gold has received research support from Novartis. The institution of Dr. Gold has received research support from Biogen.
Kerstin Hellwig (St. Josef Hospital Bochum)	Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for BMS. Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis . Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi Genzyme . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Mylan . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis . Kerstin Hellwig has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche . Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Merck . Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Novartis . Kerstin Hellwig has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Roche . The institution of Kerstin Hellwig has received research support from Roche . The institution of Kerstin Hellwig has received research support from Merck . The institution of Kerstin Hellwig has received research support from Biogen. The institution of Kerstin Hellwig has received research support from Genzyme . The institution of Kerstin Hellwig has received research support from Novartis . The institution of Kerstin Hellwig has received research support from BMS .
Olga Ciccarelli, MD, PhD, FRCP (UCL Institute of Neurology)	Prof. Ciccarelli has received personal compensation in the range of $0-$499 for serving as a Consultant for Lundebeck. Prof. Ciccarelli has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Prof. Ciccarelli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Prof. Ciccarelli has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Merck. Prof. Ciccarelli has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEUROLOGY Journal.

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