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Letter
Neuropsychological impairment in natalizumab-associated progressive multifocal leukoencephalopathy: implications for early diagnosis
  1. R Hoepner,
  2. P Klotz,
  3. S Faissner,
  4. R Schneider,
  5. M Kinner,
  6. C Prehn,
  7. R Gold,
  8. A Chan
  1. Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
  1. Correspondence to Dr R Hoepner, Department of Neurology, St Josef Hospital, Ruhr-University Bochum, Gudrunstr 56, Bochum 44879, Germany; roberthoepner@gmx.de

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Introduction

Immunocompromised patients and, recently, natalizumab (NAT)-treated patients with multiple sclerosis (MS) are at risk to develop the relatively rare but potentially fatal opportunistic central nervous system infection progressive multifocal leukoencephalopathy (PML). As rapid immune reconstitution by removal of NAT appears to determine prognosis, early diagnosis is mandatory.1 Neuropsychological symptoms are common in early stages of disease,2 yet data on neuropsychological function in NAT-PML is lacking. Few studies in HIV-associated PML have demonstrated a reduction in attention/working memory, visuospatial abilities and motor speed.3 We compare the neuropsychological performance of patients with NAT-PML with patients with relapsing–remitting (RR) MS during NAT therapy and patients with RR multiple sclerosis (RRMS) with relapse; we identify specific neuropsychological abnormalities that might support early NAT-PML diagnosis.

Methods

Our monocentric retrospective analysis of data obtained during routinely performed investigations was approved by the local ethics committee (No 4566-13). Epidemiological characteristics of patients with NAT-PML (n=8, definite diagnosis4) and controls (stable NAT-treated patients, n=9; patients with RRMS with preceding relapse, n=14) are given in table 1. The time point of NAT-PML diagnosis corresponded to first detection of JC virus DNA in cerebrospinal fluid. Neuropsychological examination included Wechsler Memory Scale (digits forwards, backwards, visual reproduction I, information and general orientation), Rey Auditory Verbal Learning test, Regensburger Word Fluency Test, Shulman Clock Drawing Test and Beck Depression Inventory II. At the time point of …

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