Deeskalation auf Interferon β-1b nach Mitoxantron- und Natalizumabgabe

A 19-year old student with temporal lobe epilepsy since the age of 15 presented with a first multifocal demyelinating clinical event (right optic neuritis, right hypaesthesia). Three years later a second relapse led to the diagnosis of relapsing-remitting multiple sclerosis (MS). Another 3 years later 6 relapses with increasing severity within 15 months signalized highly active MS. Disease activity was paused by steroids, plasma exchange and induction treatment with cyclophosphamide. A 7-year clinical steadiness was achieved by a 2 year maintenance treatment with mitoxantrone and deescalation, subsequently. After 2 more relapses, natalizumab treatment was initiated. After 16 months the patient was again deescalated to interferon β-1b. Since then, the patient developed no more relapses.