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

Brenda Huppke; Heike de Vries; Astrid Blaschek; Peter Huppke

doi:10.1055/a-2496-5294

Neuropediatrics, Inhaltsverzeichnis

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

¹Department of Pediatric Neurology, Jena University Hospital, Jena, Germany

,

Heike de Vries

¹Department of Pediatric Neurology, Jena University Hospital, Jena, Germany

,

Astrid Blaschek

²Department 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

¹Department of Pediatric Neurology, Jena University Hospital, Jena, Germany

³Center for Rare Diseases, Jena University Hospital, Jena, Germany

› Institutsangaben

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

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Referenzen

References
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