Carl R. Darnall Army Medical Center - Health Library

Progressive Multifocal Leukoencephalopathy

(PML)

Pronounced: LOO-koh-en-sef-ah-LOP-ah-thee

Definition

Progressive Multifocal Leukoencephalopathy (PML) is a rare disease that gets worse over time. It harms brain cells.

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Causes  ^

PML is caused by an infection by a specific virus. Many people get this virus as a child, but do not get sick until later. It stays in the body and does not cause problems in most.

If the immune system becomes weak, the virus can start to cause problems. It attacks the coating around the brain cells. Messages can't be passed between cells without this coating.

Risk Factors  ^

PML is most common in people who have problems with their immune system. These problems may be from:

  • HIV/AIDS (most common)
  • Leukemia and lymphoma
  • Organ transplant
  • Cancer
  • Long term use of steroid medicines
  • Rare, inherited immunodeficiencies
  • Certain medicines that treats multiple sclerosis (MS)

Symptoms  ^

You will feel worse over time. You may have:

  • Lack of strength in the arms and legs
  • Problems with movement
  • Changes in behavior and thinking
  • Problems remembering things
  • Problems seeing
  • Speech problems
  • A loss of language
  • Sensory loss
  • Seizures

Diagnosis  ^

Your doctor will ask about your symptoms and health history. A physical exam will be done.

An MRI scan will be needed to see any damage to the brain cells. This may help to rule out other causes.

To confirm PML, your doctor may need:

  • Brain biopsy—to check for changes in cells
  • Lumbar puncture—to look for the virus in the fluid that surrounds the brain

Treatment  ^

There is no way to treat the infection or PML. Treatment is aimed at ways to make your immune system better to stop further harm. It will depend on your health needs, but here are some methods:

  • If you have HIV, antiretroviral medicine will be started.
  • If medicine caused PML, your doctor will have you stop taking it.

Harm to the cells can't be fixed. This can cause severe disability.

Prevention  ^

You can’t prevent the virus that causes PML. Keep your immune system as healthy as you can. It may help prevent certain infections.

RESOURCES:

AIDS Information, Education, Action
http://www.aids.org

NORD—National Organization for Rare Disorders
http://www.rarediseases.org

CANADIAN RESOURCES:

Canadian AIDS Society
http://www.cdnaids.ca

CORD—Canadian Organization for Rare Disorders
http://www.cord.ca

REFERENCES:

Grebenciucova E, Pruitt A. Infections in patients receiving multiple sclerosis disease-modifying therapies. Curr Neurol Neurosci Rep. 2017;17(11):88.

NINDS progressive multifocal leukoencephalopathy information page. National Institute of Neurological Disorders and Stroke website. Available at https://www.ninds.nih.gov/Disorders/All-Disorders/Progressive-Multifocal-Leukoencephalopathy-Information-Page. Accessed June 25, 2018.

Progressive multifocal leukoencephalopathy. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116949/Progressive-multifocal-leukoencephalopathy-PML. Updated December 1, 2017. Accessed June 25, 2018.

Progressive multifocal leukoencephalopathy (PML). AETC National Resource Center website. Available at: http://aidsetc.org/resource/progressive-multifocal-leukoencephalopathy-pml. Updated May 1, 2013. Accessed June 25, 2018.

Warnke C, Menge T, Hartung HP, et al. Natalizumab and progressive multifocal leukoencephalopathy: what are the causal factors and can it be avoided? Arch Neurol. 2010;67(8):923-930.

Last reviewed June 2018 by EBSCO Medical Review Board Rimas Lukas, MD  Last Updated: 6/25/2018