Progressive multifocal leukoencephalopathy

Research output: Contribution to journalReview article

29 Citations (Scopus)

Abstract

Treatment of progressive multifocal leukoencephalopathy (PML) in a patient with exogenous immunosuppression starts with discontinuation of immunosuppressive medication. The restored host immunity will clear JC virus, the cause of PML, from the brain via cell-mediated immune mechanisms. Patients with solid-organ transplants will lose the transplanted organ, however, and patients who have autoimmune disorders may experience exacerbation of their underlying disease. These factors need to be weighed against the potentially fatal nature of PML. If the patient's immunosuppression is AIDS-related, highly active antiretroviral therapy (HAART) should be initiated if it has not previously been used. If the patient is already receiving HAART, the therapy should be changed to optimize treatment, with the goals of a nondetectable HIV viral load and normalization or near normalization of the CD4 count. For non-AIDS PML patients, daily intravenous cytosine arabinoside for 5 days can be offered if the patient is not pancytopenic and can tolerate a chemotherapeutic agent. For AIDS patients with PML or failing non-AIDS patients with neurologic deterioration, cidofovir can be considered. These therapies can be offered if neurologic stabilization satisfies the quality-of-life goals for the patient. For patients intolerant of other therapies or unsuited to them, oral mirtazapine or risperidone can be considered. The safety of these agents has been established in the treatment of psychiatric disease, but their efficacy has not yet been proven. Small interfering RNA (siRNA) therapy holds the promise of specific antiviral therapy, but delivery methods, safety, and efficacy are yet to be established.

Original languageEnglish (US)
Pages (from-to)178-185
Number of pages8
JournalCurrent Treatment Options in Neurology
Volume10
Issue number3
DOIs
StatePublished - May 1 2008

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Progressive Multifocal Leukoencephalopathy
Highly Active Antiretroviral Therapy
Therapeutics
Immunosuppression
Nervous System
Acquired Immunodeficiency Syndrome
JC Virus
Safety
Risperidone
Cytarabine
Immunosuppressive Agents
CD4 Lymphocyte Count
Viral Load
Small Interfering RNA
Antiviral Agents
Psychiatry
Immunity

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Progressive multifocal leukoencephalopathy. / Aksamit, Allen Jr.

In: Current Treatment Options in Neurology, Vol. 10, No. 3, 01.05.2008, p. 178-185.

Research output: Contribution to journalReview article

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