A patient with established primary progressive multiple sclerosis transitions to ‘secondary’ relapsing–remitting disease course following a fulminant demyelinating episode

• Published in: Multiple sclerosis Vol. 17; no. 10; pp. 1262 - 1264
• Main Authors: Tutuncu, Melih, Demirci, Nuri O, Özer, Feriha, Saip, Sabahattin, Kantarci, Orhun H, Siva, Aksel
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.10.2011; Sage Publications; Sage Publications Ltd
• Subjects: Adult; Biological and medical sciences; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Disease Progression; Humans; Immunosuppressive Agents; Male; Medical sciences; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Multiple Sclerosis, Chronic Progressive - complications; Multiple Sclerosis, Chronic Progressive - drug therapy; Multiple Sclerosis, Chronic Progressive - pathology; Multiple Sclerosis, Relapsing-Remitting - complications; Multiple Sclerosis, Relapsing-Remitting - drug therapy; Multiple Sclerosis, Relapsing-Remitting - pathology; Neurology; Recurrence; Respiratory Tract Infections - complications; Urinary Tract Infections - complications; Young Adult; progressive; multiple sclerosis; Fulminant; Human; Nervous system diseases; Multiple sclerosis; Central nervous system disease; Transition; Degenerative disease; Inflammatory disease
• ISSN: 1352-4585; 1477-0970
• DOI: 10.1177/1352458510387183

Primary progressive multiple sclerosis (PPMS), relapsing remitting MS (RRMS) and acute disseminated encephalomyelitis (ADEM) are clinically and immunopathogenetically distinct phenotypes of inflammatory demyelinating disorders of the central nervous system. Progression following RRMS is well described as secondary progressive MS. We report a patient with unexpected transition from long established PPMS to clinically and radiologically active RRMS after an ADEM-like fulminant demyelinating episode despite an immunosuppressive treatment preceding relapses. We note clearly accelerated brain atrophy after the RRMS course ensues. The unique disease course in this patient illustrates the dissociation of the biology and disability impact of relapses and progression.