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Neuropediatrics 2025; 56(02): 147-150
DOI: 10.1055/a-2496-5294
Short Communication

Severe Disease Activation after Fingolimod Discontinuation in a Pediatric Multiple Sclerosis Patient: A Case Report and Literature Review

Brenda Huppke
1   Department of Pediatric Neurology, Jena University Hospital, Jena, Germany
,
Heike de Vries
1   Department of Pediatric Neurology, Jena University Hospital, Jena, Germany
,
Astrid Blaschek
2   Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Ludwig-Maximilians-Universität München, Dr. von Hauner Children's Hospital, LMU Hospital, Munich, Germany
,
Peter Huppke 
1   Department of Pediatric Neurology, Jena University Hospital, Jena, Germany
3   Center for Rare Diseases, Jena University Hospital, Jena, Germany
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Abstract

Adult reports of unexpected severe disease worsening, often termed “rebound,” shortly after discontinuing fingolimod in a subset of patients with multiple sclerosis (MS), have grown over the last decade. This phenomenon, however, remains poorly described in pediatric MS patients. We present findings of a 15-year-old who experienced a debilitating relapse 4 weeks after stopping fingolimod to switch to ocrelizumab. Imaging revealed multiple large new lesions far exceeding any previously observed activity level in the patient. Despite prompt high-dose corticosteroids, plasma exchange, and prolonged rehabilitation therapy, significant residual deficits involving cognition, balance, and vision remain from the attack. This case underscores that pediatric MS patients are also at risk of severe disease deterioration after fingolimod withdrawal and require close monitoring when switching therapies.

Keywords

pediatric multiple sclerosis - rebound - fingolimod

Ethical Statement

Written informed consent was obtained for this report.


Supplementary Material



Publikationsverlauf

Eingereicht: 20. August 2024

Angenommen: 02. Dezember 2024

Accepted Manuscript online:
05. Dezember 2024

Artikel online veröffentlicht:
20. Dezember 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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