Predictors of severity and functional outcome in natalizumab-associated progressive multifocal leukoencephalopathy.

Hoepner, Robert; Kolb, Eva M; Dahlhaus, Stefanie; Hellwig, Kerstin; Adams, Ortwin; Kleiter, Ingo; Salmen, Anke; Schneider, Ruth; Lukas, Carsten; Chan, Andrew; Berger, Joseph R; Gold, Ralf (2016). Predictors of severity and functional outcome in natalizumab-associated progressive multifocal leukoencephalopathy. Multiple sclerosis journal, 23(6), pp. 830-835. Sage 10.1177/1352458516667241

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Progressive multifocal leukoencephalopathy (PML) is an emerging complication of immunosuppressive therapies, especially natalizumab in multiple sclerosis (MS). Factors associated with functional outcome of natalizumab-associated PML (natalizumab-PML) have not been sufficiently described.


We retrospectively analyzed medical records of all patients with natalizumab-PML (n = 32) treated in our hospital since 2009. Disability measured by Expanded Disability Status Scale (EDSS) at two different time points (highest available EDSS during PML and last available EDSS after PML diagnosis) served as functional outcome parameters. Clinical, laboratory, and imaging data were analyzed for association with functional outcome by applying Spearman's rho and multivariate regression analysis.


In all, 31/32 patients survived PML. A poor functional outcome was associated with higher age, higher initial John Cunningham virus (JCV) copy number in cerebrospinal fluid (CSF), and more extensive PML lesions on initial magnetic resonance imaging (MRI). No association between functional outcome and the duration of natalizumab therapy or a delayed PML diagnosis was observed.


This study will be useful for neurological practice to estimate functional outcome or disease severity of natalizumab-PML in primary care settings.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DCR Unit Sahli Building > Forschungsgruppe Neurologie
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Salmen, Anke, Chan, Andrew Hao-Kuang


600 Technology > 610 Medicine & health








Stefanie Hetzenecker

Date Deposited:

03 Oct 2016 15:51

Last Modified:

02 Mar 2023 23:28

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Expanded Disability Status Scale; John Cunningham Virus; Tysabri; long-term follow-up; multiple sclerosis; very late antigen-4


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