Prescribers are being advised to contact patients who have discontinued daclizumab to ensure they are aware of the symptoms of immune-mediated encephalitis after cases were reported several months after discontinuing the drug.
Daclizumab was voluntarily withdrawn from the worldwide market by its manufacturer in March 2018 due to mounting concerns over its safety. Physicians were advised then to switch patients to an alternative treatment as soon as possible.
Now the UK Medicines and Healthcare products Regulatory Agency has issued updated advice stating that clinicians should:
Monitor for encephalitis for 12 months following discontinuation of daclizumab
Ensure all patients who have discontinued daclizumab and their carers are aware of the common prodromal symptoms and early neuropsychiatric, behavioural, neurological, cognitive, or movement-related symptoms of encephalitis and the need to contact their doctor immediately if they occur
Have a high index of suspicion for autoimmune encephalitis if a patient presents with atypical neuropsychiatric symptoms.
Demyelinating central nervous system condition clinically defined by 2 episodes of neurological dysfunction (brain, spinal cord, or optic nerves) that are separated in space and time.
Classically presents in white women, aged between 20 to 40 years, with temporary visual or sensory loss. However, may affect either sex and any age or ethnic group, and may have variable neurological symptom location and/or duration.
May have subtle changes in vision, ambulation, and reflexes on examination that provide evidence of previous attacks (which may not have been noticed by the patient).
Magnetic resonance imaging (MRI) of the brain is sensitive, but very susceptible to over-interpretation in the absence of clinical correlation. Spinal MRI is abnormal less often, but lends greater specificity when present with brain lesions.
Treatment of the condition can be divided into 3 parts: treatment of the acute attack; prevention of future attacks by reducing triggers and use of disease-modifying therapies; and symptomatic treatments of neurological difficulties such as spasticity, pain, fatigue, and bladder dysfunction.
Multiple sclerosis (MS) is defined as an inflammatory demyelinating disease characterised by the presence of episodic neurological dysfunction in at least 2 areas of the central nervous system (brain, spinal cord, and optic nerves) separated in time and space. 
Mellen Center for MS Treatment and Research
Cleveland Clinic Foundation
MAW has received payment for participating on the speakers' bureaus of Biogen, Genzyme, and Novartis. MAW also serves on the editorial board for the International Journal of MS Care.
Dr Mary Alissa Willis would like to gratefully acknowledge Dr Lael A. Stone, a previous contributor to this topic. LAS declares that she has no competing interests.
Project Leader for Neurology
ARG declares that he has no competing interests.
Associate Professor of Neurology
Department of Clinical Neurological Sciences
London Health Sciences Centre
SAM declares that she has no competing interests.
The London Multiple Sclerosis Clinic
Schulich School of Medicine
University of Western Ontario
Clinical Neurological Sciences Department
London Health Sciences Centre
MK declares that he has no competing interests.
Department of Neurology
AC declares that he has no competing interests.
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