This is a case report of a subject who developed extensive brain lesions during fingolimod (FTY720) treatment in the TRANSFORMS study. His initial diagnosis was MS, but after developing an encephalopathy (confusion with clouding of conciousness) and the detection of anti-aquaporin4 antibody (anti-AQP4 Ab), the diagnosis was changed to neuromyelitis optica (NMO) spectrum disorder. After treatment with fingolimod, he developed bilateral extensive brain lesions. The brain MRI showed lesions predominantly involving the right frontal and parietal lobes, with swelling (vasogenic edema) and enhancement (breakdown of the blood-brain-barrier). He had no recurrence with steroid treatment over 3 years following withdrawal of fingolimod.
Epub ahead of print: Min et al. Development of extensive brain lesions following fingolimod (FTY720) treatment in a patient with neuromyelitis optica spectrum disorder. Mult Scler. 2011 Dec 6.
“There are lessons here for both neurologists and MS’ers. (1) It is important to make the correct diagnosis of MS before starting treatment. (2) Fingolimod is unlikely to be effective in NMO. (3) NMO is a separate disease entity; it is not related to MS.”