Multiple Sclerosis Resource Centre

Welcome to the Multiple Sclerosis Resource Centre. This website is intended for international healthcare professionals with an interest in Multiple Sclerosis. By clicking the link below you are declaring and confirming that you are a healthcare professional

You are here

Bilateral trochlear nerve palsy in a patient with neuromyelitis optica

Annika Plate, Joachim Havla, Tania Kümpfel

In June 2011, a 71-year-old female Caucasian patient was found to have low neutrophil counts (410 granulocytes/µl; 2.3G/l leucocytes) during a routine blood cell count (BCC) control.

The last contact was in March of that same year, when the patient received her latest cycle of rituximab (RX) therapy in light of her neuromyelitis optica (NMO). She was diagnosed with NMO in 1990 due to recurrent longitudinally extensive myelitis(LEM) and optic neuritis(ON). In 2005 the diagnosis was confirmed when she tested positive for aquaporin-4 antibodies. From 1999 through 2008 she was treated with azathioprine, but still showed clinical disease. In December 2008 the patient was switched to RX. She received her first RX cycle in December 2008, consisting of two 1000 mg infusions, two weeks apart. Further cycles of RX therapy were received in June 2009, February 2010, August 2010 and the latest in March 2011. RX led to complete B-cell depletion and stabilisation of disease activity. Besides B-cell depletion, differential BCC have always been unremarkable, until June 2011.

 

Based on these findings, what action should be taken?

For more information on this case please click the link below

Search this site

Stay up-to-date with our monthly e-alert

If you want to regularly receive information on what is happening in MS research sign up to our e-alert.

Subscribe »

About the Editors

  • Prof Timothy Vartanian

    Timothy Vartanian, Professor at the Brain and Mind Research Institute and the Department of Neurology, Weill Cornell Medical College, Cornell...
  • Dr Claire S. Riley

    Claire S. Riley, MD is an assistant attending neurologist and assistant professor of neurology in the Neurological Institute, Columbia University,...
  • Dr Rebecca Farber

    Rebecca Farber, MD is an attending neurologist and assistant professor of neurology at the Neurological Institute, Columbia University, in New...

This online Resource Centre has been made possible by a donation from EMD Serono, Inc., a business of Merck KGaA, Darmstadt, Germany.

Note that EMD Serono, Inc., has no editorial control or influence over the content of this Resource Centre. The Resource Centre and all content therein are subject to an independent editorial review.

The Grant for Multiple Sclerosis Innovation
supports promising translational research projects by academic researchers to improve understanding of multiple sclerosis (MS) for the ultimate benefit of patients.  For full information and application details, please click here

Journal Editor's choice

Recommended by Prof. Brenda Banwell

Causes of death among persons with multiple sclerosis

Gary R. Cutter, Jeffrey Zimmerman, Amber R. Salter, et al.

Multiple Sclerosis and Related Disorders, September 2015, Vol 4 Issue 5