The twisted role of natalizumab and rehabilitation in an aggressive form of multiple sclerosis: a case report

Abstract

Multiple sclerosis is one of the main causes of neurological disability among young people, severely influencing life’s quality. Motor deficit is one of the most invalidating symptoms in multiple sclerosis. Motor involvement at onset, spinal demyelinating lesion distribution, highly active lesions, high frequency of relapses in the first 2 years after disease onset and post relapse residual disability with poor recovery, later age at onset and male gender represent unfavorable prognostic factors. Considering the significant role of prognostic factors in predicting the evolution of the disease, an induction treatment approach should always be considered. In this report we present the case of a middle-aged male patient presenting severe weakness and sensitive symptoms with a challenging therapeutic decision that had a favorable recovery after reconsidering the initial therapy. The recognition of aggressive forms of multiple sclerosis is mandatory in preventing further disability, improving the patient’s quality of life. Natalizumab is a monoclonal antibody used for the aggressive forms of multiple sclerosis, reducing the lymphocytes traffic through the blood brain barrier, with a great impact on relapses frequency and disease evolution. Keywords: aggressive multiple sclerosis, brain derived neurotrophic factor, natalizumab, rehabilitation,