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The cases reported here suggest that dimethyl fumarate, which reduces the number of Th1 and Th17 cells and induces IL-4-producing Th2 cells, is also unsuitable for neuromyelitis optica spectrum disorder, irrespective of anti-aquaporin 4 IgG serostatus. Although oral dimethyl fumarate with manageable adverse effects is easy to initiate in the early course of multiple sclerosis, special attention should be paid for atypical demyelinating cases.<\/jats:p>","DOI":"10.1177\/1352458517703803","type":"journal-article","created":{"date-parts":[[2017,4,10]],"date-time":"2017-04-10T04:46:11Z","timestamp":1491799571000},"page":"1300-1302","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":38,"title":["Unexpected exacerbations following initiation of disease-modifying drugs in neuromyelitis optica spectrum disorder: Which factor is responsible, anti-aquaporin 4 antibodies, B cells, Th1 cells, Th2 cells, Th17 cells, or others?"],"prefix":"10.1177","volume":"23","author":[{"given":"Jun-ichi","family":"Kira","sequence":"first","affiliation":[{"name":"Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2017,4,10]]},"reference":[{"key":"bibr1-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2377-14-21"},{"key":"bibr2-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1177\/1352458517694086"},{"key":"bibr3-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1206328"},{"key":"bibr4-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1114287"},{"key":"bibr5-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2249.2006.03094.x"},{"key":"bibr6-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awq386"},{"key":"bibr7-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1124\/jpet.111.190132"},{"key":"bibr8-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-015-1422-3"},{"key":"bibr9-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1172\/JCI72151"},{"key":"bibr10-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbrc.2009.06.085"},{"key":"bibr11-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1002\/ana.21837"},{"key":"bibr12-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1603907113"},{"key":"bibr13-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1084\/jem.20100977"},{"key":"bibr14-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1177\/1352458515608961"},{"key":"bibr15-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000000183"},{"key":"bibr16-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0124923"},{"key":"bibr17-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1177\/1352458512463768"},{"key":"bibr18-1352458517703803","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3182735cb3"}],"container-title":["Multiple Sclerosis Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1352458517703803","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1352458517703803","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1352458517703803","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T03:50:19Z","timestamp":1777693819000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1352458517703803"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4,10]]},"references-count":18,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2017,8]]}},"alternative-id":["10.1177\/1352458517703803"],"URL":"https:\/\/doi.org\/10.1177\/1352458517703803","relation":{},"ISSN":["1352-4585","1477-0970"],"issn-type":[{"value":"1352-4585","type":"print"},{"value":"1477-0970","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,4,10]]}}}