Acute relapse after initiation of Siponimod in a patient with secondary progressive MS.

Sphingosine 1-phosphate (S1P) is a signaling molecule that binds to five G protein-coupled receptors (Proc Natl Acad Sci USA 108:751-756, 2011). Modulation of these receptors has been associated with pleiotropic biological effects in the immune, cardiovascular, and central nervous systems (CNS). The functional S1P receptor antagonist fingolimod was the first member of this class of pharmacotherapeutics to be approved for treatment of relapsing multiple sclerosis (MS).

Reliability and repeatability of the Hoffmann sign.

Objective: To determine the inter-rater, intrarater, and intrasubject reliability of the Hoffmann sign.

Design: Observational, cross-sectional study.

Setting: Veterans Affairs medical center.