Recent years have seen significant increases in the numbers of patients with multiple sclerosis (MS) receiving treatment with new immunomodulatory drugs. The number of cases in which these drugs are withdrawn because of side effects, intolerance, inadequate efficacy or planned pregnancy also increases. We present here a review of the problem of severe complications associated with the termination of treatment with natalizumab and fingolimod, in the form of immune reconstitution inflammatory syndrome (IRIS) and ricochet syndrome (withdrawal syndrome or rebound syndrome). The history of the term IRIS is considered, along with the diagnostic criteria for this syndrome in patients infected with human immunodeficiency virus. Variants of IRIS in patients interrupting natalizumab treatment are described. The clinical and radiological signs are assessed, as are the possible mechanisms of development of rebound syndrome on withdrawal of natalizumab and fingolimod treatment. The need for developing diagnostic criteria and studying risk factors for the development of IRIS and rebound syndrome in MS patients terminating therapy with new immunomodulatory drugs is emphasized.
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