Figure 1

Schematic overview of disease course. (A) Disease course from diagnosis, including (B) quantification of MRI (T1gado, T2 and T2 FLAIR) before and after start of fingolimod. Shown are patient’s treatment regime, relapses (in closed dots when treated with methylprednisolone (MP), in open dots when untreated), time points of all MRI and EDSS scores. The lower part of the figure (B) shows the last five, most relevant, subsequent T2 FLAIR and T1 Gd MRI’s. T2 lesion count and lesion load (measured using conventional T2 MRI and FLAIR MRI) and T1 Gd lesion counts are shown. T2 lesion count and lesion load were quantified by an expert reader in MIPAV (version 5.1.1, Center for Information Technology, Bethesda, Maryland). At follow up visits subtracted images were used for MRI analyses. Total T2 lesion load at follow up was calculated as the lesion load at baseline (MRI 1) plus negative and/or positive activity change. Time points of MRI in MS course: MRI 1 – before start of natalizumab treatment (during exacerbation). MRI 2 – just after restart natalizumab treatment (remission). MRI 3 – during exacerbation 4 months after natalizumab discontinuation before plasmapheresis. MRI 4 – during exacerbation 4 months after natalizumab discontinuation after plasmapheresis. MRI 5 – 8 months after start of fingolimod (remission). Abbreviations: DMT: disease modifying therapy; EDSS: Expanded Disability Status Scale; FLAIR: Fluid Attenuation Inversion Recovery.