Because the treatment of multiple sclerosis (MS) may span decades, the need often arises to make changes to the treatment plan in order to accommodate changing circumstances. Switching drugs, or the discontinuation of immunomodulatory agents altogether, may leave patients vulnerable to relapse or disease progression. In some cases, severe MS disease activity is noted clinically and on MRI after treatment withdrawal. When this disease activity is disproportionate to the pattern observed prior to treatment initiation, patients are said to have experienced rebound. Of the US Food and Drug Administration (FDA)-approved agents to treat MS, the drugs most commonly implicated in rebound are natalizumab and fingolimod. In this review based on the reported cases and data from clinical trials, we characterize disease rebound after fingolimod cessation. We also outline fingolimod rebound management considerations, summarizing what evidence is available to help clinicians mitigate the risk of rebound, switch therapies, and treat rebound events when they occur. The commonly encountered situation of fingolimod discontinuation prior to pregnancy is also discussed.

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Summary Angiographic assessment of cerebro‐vascular disease requires films of high quality and information regarding all extracranial and intra‐cranial vessels. Direct carotid puncture and arch aortography are considered inadequate in several important respects. Four hundred trans‐femoral selective catheter studies have been reviewed to determine if this method offers a practical alternative. The technique was totally successful in 95.5% and diagnostic information was invariably of high quality. This method is recommended as the procedure of choice in the angiographic examination of ischaemic cerebral disease.