Catastrophic brain relapse in seronegative NMO after a single dose of natalizumab

J Neurol Sci. 2014 Apr 15;339(1-2):223-5. doi: 10.1016/j.jns.2014.01.035. Epub 2014 Feb 4.


Natalizumab, an effective treatment for MS, has been shown to exacerbate neuromyelitis optica (NMO) with aquaporin-4 antibodies, but whether this is the case in antibody negative NMO and atypical MS/NMO spectrum disorder overlap syndromes is unknown. We describe a patient with a relapsing optico-spinal demyelinating syndrome, negative for aquaporin-4 antibodies, who experienced a catastrophic brain relapse shortly after a single dose of natalizumab, highlighting that MS immunomodulatory drugs may worsen demyelination in patients with seronegative NMO and atypical MS/NMO overlap syndromes even if they are aquaporin-4 antibody negative. We summarise the treatments considered safe and effective in NMO, and those with potential to exacerbate disease.

Keywords: AQP4; Aquaporin-4; Devic's disease; NMO; Natalizumab; Neuromyelitis optica.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Antibodies, Monoclonal, Humanized / adverse effects*
  • Brain / drug effects*
  • Brain / pathology*
  • Catastrophic Illness
  • Female
  • Humans
  • Integrin alpha4*
  • Natalizumab
  • Neuromyelitis Optica / blood
  • Neuromyelitis Optica / drug therapy*


  • Antibodies, Monoclonal, Humanized
  • Natalizumab
  • Integrin alpha4