{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T17:36:59Z","timestamp":1770831419307,"version":"3.50.1"},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neuropediatrics"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Adult reports of unexpected severe disease worsening, often termed \u201crebound,\u201d 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.<\/jats:p>","DOI":"10.1055\/a-2496-5294","type":"journal-article","created":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T01:07:22Z","timestamp":1733447242000},"page":"147-150","source":"Crossref","is-referenced-by-count":1,"title":["Severe Disease Activation after Fingolimod Discontinuation in a Pediatric Multiple Sclerosis Patient: A Case Report and Literature Review"],"prefix":"10.1055","volume":"56","author":[{"given":"Brenda","family":"Huppke","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, Jena University Hospital, Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heike de","family":"Vries","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, Jena University Hospital, Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Astrid","family":"Blaschek","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology and Developmental Medicine and LMU Center for Children with Medical Complexity, Ludwig-Maximilians-Universit\u00e4t M\u00fcnchen, Dr. von Hauner Children's Hospital, LMU Hospital, Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1183-4905","authenticated-orcid":false,"given":"Peter","family":"Huppke","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, Jena University Hospital, Jena, Germany"},{"name":"Center for Rare Diseases, Jena University Hospital, Jena, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,12,20]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1007\/s40265-020-01431-8","article-title":"Sphingosine 1-phosphate receptor modulator therapy for multiple sclerosis: differential downstream receptor signalling and clinical profile effects","volume":"81","author":"J Chun","year":"2021","journal-title":"Drugs"},{"issue":"07","key":"ref2","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1001\/jamaneurol.2016.0826","article-title":"Rebound syndrome in patients with multiple sclerosis after cessation of fingolimod treatment","volume":"73","author":"S E Hatcher","year":"2016","journal-title":"JAMA Neurol"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.jneuroim.2015.03.022","article-title":"Severe disease reactivation in four patients with relapsing-remitting multiple 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sclerosis","volume":"16","author":"N Cerd\u00e1-Fuertes","year":"2023","journal-title":"Ther Adv Neurol Disord"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"102918","DOI":"10.1016\/j.msard.2021.102918","article-title":"Recurrence of disease activity after fingolimod discontinuation in older patients previously stable on treatment","volume":"51","author":"V Pantazou","year":"2021","journal-title":"Mult Scler Relat Disord"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1177\/1756286419846818","article-title":"Severe rebound after cessation of fingolimod treated with ocrelizumab with coincidental transient aggravation: report of two cases","volume":"12","author":"S Schmidt","year":"2019","journal-title":"Ther Adv Neurol Disord"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1007\/s00415-013-6933-z","article-title":"Rebound after fingolimod suspension in a pediatric-onset multiple sclerosis 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immunosuppression in a model of post-fingolimod MS rebound","volume":"50","author":"L Cavone","year":"2015","journal-title":"Brain Behav 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