Peripheral B cell depletion and central proinflammatory cytokine reduction following repeated intrathecal administration of rituximab in progressive Multiple Sclerosis

B cells and/or the enhanced inflammatory milieu in the subarachnoid space are supposed to have a role in cortical pathology of progressive multiple sclerosis (PMS). The efficacy of intravenous rituximab to deplete circulating B cells is remarkable in MS, and its intrathecal delivery could target compartmentalized inflammation in PMS. We describe the central and peripheral effects of repeated intrathecal rituximab administrations in a patient with severe PMS. Peripheral CD20+ B cells were reduced, while oligoclonal bands were unaffected. Several central proinflammatory cytokines, and markers of neurodegeneration were markedly reduced. Central B cells modulation should be investigated in PMS.