Neuroimmunology

Question 1

Mechanism of action of natalizumab

Answer 1

Antibody against alpha4-integrin, a cellular adhesion molecule. Reduces entry of lymphocytes into CNS

Question 2

Mechanism of action of fingolimod

Answer 2

Sphingosine-1 phosphate modulator, which inhibits lymphocytes from leaving lymph notes (trapping them there)

Question 3

Mechanism of action of alemtuzumab

Answer 3

Antibody against CD52 on both B ant T lymphocytes as well as many monocytes, macrophages, and NK cells

Question 4

Specific risks of alemtuzumab (in addition to immunosuppression including PML, bone marrow suppression, infusion reactions, and malignancy)

Answer 4

1. Hyperthyroidism
2. ITP (and other autoimmune conditions, including anti-basement membrane disease, HLH, Still’s disease, and autoimmune encephalitis)

Question 5

Teriflunomide mechanism of action

Answer 5

Inhibits dihyroorotate dehydrogenase, a mitochondrial enzyme involved in pyrimidine synthesis

Question 6

Specific risks of teriflunomide

Answer 6

Liver injury
Teratogenic (category X)
SJS

Question 7

Treatment of faciobrachial dystonic seizures in LGI1 encephalitis

Answer 7

Immunosuppression

(Generally refractory to ASMs)

Question 8

What is Balo’s concentric sclerosis?

Answer 8

Form of demyelination with concentric sclerosis, may appear as onion skin lesion on MRI. Generally seen as a rare MS variant.