A Practical Guide to the Treatment of Neuromyelitis Optica
A Practical Guide to the Treatment of Neuromyelitis Optica
As they are both treated in the same way, we refer to NMO and NMOSD under the umbrella term of NMOSDs. We refer to the first event as the onset attack and subsequent attacks as relapses. The treatment paradigms are similar to other antibody-mediated conditions, such as myasthenia gravis (MG). Our treatment regimens apply to adults, although similar principles apply to children, with input from paediatric physicians.
From the onset it is crucial to establish that the patient understands the aims of treatment: prevention of relapses and effective treatment of relapses to limit disability resulting from any relapses that do occur. This requires patients' urgent reporting of relapses and their concordance with immunosuppressive therapy. It is important to be open about the irreversibility of longstanding neurological deficits and the role of symptomatic treatments.
In contrast to the European guidelines we (a) do not recommended rituximab as first line and (b) recommend immunosuppressive therapy in limited phenotypes with AQP4 antibodies, whatever the relapse frequency or severity, because of the high risk of relapses and disability in the future. In fact, approximately one-third of our patients with relapsing NMO have a non-severe onset attack.
There are three aspects to treatment:
Principles of Management
As they are both treated in the same way, we refer to NMO and NMOSD under the umbrella term of NMOSDs. We refer to the first event as the onset attack and subsequent attacks as relapses. The treatment paradigms are similar to other antibody-mediated conditions, such as myasthenia gravis (MG). Our treatment regimens apply to adults, although similar principles apply to children, with input from paediatric physicians.
From the onset it is crucial to establish that the patient understands the aims of treatment: prevention of relapses and effective treatment of relapses to limit disability resulting from any relapses that do occur. This requires patients' urgent reporting of relapses and their concordance with immunosuppressive therapy. It is important to be open about the irreversibility of longstanding neurological deficits and the role of symptomatic treatments.
In contrast to the European guidelines we (a) do not recommended rituximab as first line and (b) recommend immunosuppressive therapy in limited phenotypes with AQP4 antibodies, whatever the relapse frequency or severity, because of the high risk of relapses and disability in the future. In fact, approximately one-third of our patients with relapsing NMO have a non-severe onset attack.
There are three aspects to treatment:
Relapse treatment
Relapse prevention
Symptom management and rehabilitation.