Seizure as a Manifestation of Fingolimod Rebound Syndrome: A Case Report and Literature Review

Abstract

Background: Multiple sclerosis (MS) is a chronic autoimmune disease that affects the central nervous system, leading to inflammation and damage to the protective covering of nerve fibers. MS patients have an increased risk of developing epileptic seizures compared to the general population. The incidence of seizures in MS patients varies across different studies, ranging from 0.5% to 8.3%. Fingolimod is an oral medication used for the treatment of relapsing-remitting MS. It works by inhibiting sphingosine 1-phosphate receptors, which helps to reduce inflammation and prevent immune cells from attacking the nervous system. However, discontinuation of Fingolimod therapy can lead to withdrawal symptoms and potentially increase the risk of epileptic seizures in MS patients. Methods: In this case report, we aimed to present a rare manifestation of seizure as a rebound activity following discontinuation of Fingolimod therapy. We reviewed the existing literature to explore the association between Fingolimod and seizures in MS patients. Relevant studies and case reports were identified through a comprehensive search of electronic databases. Results: Our case report describes a patient who experienced a seizure after discontinuing Fingolimod therapy. This suggests that abrupt withdrawal of Fingolimod may trigger rebound activity, including seizures, in some MS patients. The literature review revealed several other cases reporting seizures or convulsions associated with Fingolimod use in MS patients. The incidence of seizures in these cases varied, highlighting the need for further research to determine the exact risk. Conclusion: Fingolimod discontinuation can lead to rebound activity, including seizures, in some MS patients. It is important for healthcare professionals to be aware of this potential risk and carefully manage the discontinuation process. Further research is needed to better understand the incidence and mechanisms underlying Fingolimod-associated seizures in MS patients.