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RNS – Closed-Loop Stimulation — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersRNS – Closed-Loop StimulationSCE Neurology

A patient taking dimethyl fumarate has absolute lymphocyte counts of 0.42, 0.39, 0.44 and 0.41×10^9/L over 7 months. There is no current infection or neurological change. What action is specified by the SmPC?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Discontinue dimethyl fumarate and follow lymphocytes until recovery

Explanation lettering: D = shown as A · C = shown as B · B = shown as C · E = shown as D · A = shown as E

A is correct. Severe lymphopenia below 0.5×10^9/L sustained for more than six months is a discontinuation threshold, with counts followed until recovery. B invents a lower cut-off. C under-monitors a recognised PML risk. D uses the temporary tolerability-reduction regimen in place of required discontinuation. E is unsafe because negative JCV serology does not exclude future infection or remove the lymphocyte-based action threshold.

Reference: Tecfidera 240 mg — SmPC: https://www.medicines.org.uk/emc/product/10096/smpc