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MS – Low JCV Index Management — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS – Low JCV Index ManagementSCE Neurology

A patient on natalizumab for highly active multiple sclerosis becomes JC-virus-antibody positive after prolonged treatment but has no new neurological symptoms. What is the best next step?

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Correct answer: D — Reassess individual PML risk and treatment alternatives with the MS specialist team, with neurological reassessment

The best answer is “Reassess individual PML risk and treatment alternatives with the MS specialist team, with neurological reassessment”. Seroconversion changes PML risk but does not itself diagnose PML; duration, antibody index, prior immunosuppression and rebound risk inform shared specialist decisions. “Continue indefinitely without further JC-virus testing or MRI” is plausible in a different neurological context, but the decisive findings here argue against it. “Diagnose PML solely from antibody seroconversion” is plausible in a different neurological context, but the decisive findings here argue against it. “Perform lumbar puncture every month despite absent clinical or MRI concern” is plausible in a different neurological context, but the decisive findings here argue against it. “Stop all disease-modifying treatment permanently without shared risk assessment” is plausible in a different neurological context, but the decisive findings here argue against it.

Reference: NICE NG220 multiple sclerosis recommendations: https://www.nice.org.uk/guidance/ng220/chapter/Recommendations