Neuromyelitis Optica: Treatment Options and Risks

Q: Neuromyelitis Optica: Treatment Options and Risks

Hello： Neuromyelitis optica is a condition in which the body produces antibodies that attack its own nervous system, thus requiring immunosuppressants for treatment. <br>Both corticosteroids and mycophenolate mofetil are immunosuppressants that can lead to decreased immunity. <br

Neuromyelitis optica

Hello, Dr.
Huang! Thank you very much for your previous guidance! After following your advice, I immediately went to the emergency room for treatment.
Due to the rapid deterioration of my condition and the resident physician's concern that the situation had been prolonged for too long, they recommended an immediate lumbar puncture for cerebrospinal fluid analysis that night.
Thanks to the resident physician's proactive approach, my diagnosis was clarified within two days as "neuromyelitis optica." Prior to this, there was a suspicion of "multiple sclerosis." I am currently undergoing a treatment regimen of 1 gram of steroids injected daily for 6 hours over a total of 3 days.
After the first and second days of treatment, the deterioration has stopped, and I am beginning to regain strength in my limbs, with improved walking ability.
Therefore, I will continue with the 0.6-gram steroid regimen for the fourth and fifth days, and after the treatment concludes, I will switch to oral steroids to manage my condition.

I would like to ask you about the post-discharge treatment options.
There is an oral steroid medication to control the risk of relapse, and there is also a "biologic agent" injection regimen for one year, which I have heard is more effective in preventing relapses.
However, the side effect is a decrease in immunity, making one more susceptible to other infections.
We are concerned that a relapse could lead to a more severe condition, so we are considering the biologic treatment, but we are also worried about the potential for decreased immunity leading to other health issues.
Additionally, we are concerned that choosing steroids might still leave us facing the risk of relapse in the future.
Could you please provide us with some recommendations for consideration? Thank you very much!

Rachel, 50~59 year old female. Ask Date: 2024/04/26

Dr. Huang Hongling reply Neurology

Hello: Neuromyelitis optica is a condition in which the body produces antibodies that attack its own nervous system, thus requiring immunosuppressants for treatment.
Both corticosteroids and mycophenolate mofetil are immunosuppressants that can lead to decreased immunity.
Long-term use of corticosteroids can result in side effects such as moon facies, buffalo hump, osteoporosis, and also a reduction in immune function.
Therefore, a second-line immunosuppressant is usually added to the treatment regimen (for example, mycophenolate mofetil).
Mycophenolate mofetil is a good medication, and if you have any concerns, it is advisable to discuss them with your attending physician for clearer understanding!

Reply Date: 2024/04/26

More Info

Neuromyelitis Optica (NMO), also known as Devic's disease, is a serious autoimmune disorder that primarily affects the optic nerves and spinal cord. The treatment options for NMO typically involve the use of corticosteroids and immunosuppressive therapies, which can help manage acute attacks and prevent future relapses. Given your current situation, it is important to weigh the benefits and risks of each treatment option carefully.

Current Treatment and Its Efficacy
You mentioned that you are currently receiving intravenous corticosteroids, which is a common first-line treatment for acute exacerbations of NMO. Corticosteroids work by reducing inflammation and suppressing the immune response, which can help alleviate symptoms and prevent further damage to the optic nerves and spinal cord. The fact that you have already seen improvement in your strength and mobility is a positive sign, indicating that the treatment is effective in managing your acute symptoms.

Long-term Management Options
After the initial treatment phase, the focus shifts to long-term management to prevent relapses. Oral corticosteroids can be prescribed, but they come with their own set of side effects, including weight gain, osteoporosis, and increased risk of infections. Therefore, many patients and physicians consider alternative immunosuppressive therapies.

One such option you mentioned is the use of monoclonal antibodies, such as aquaporumab or other biologics. These treatments have shown promise in reducing the frequency of relapses in patients with NMO. However, as you pointed out, they can also lead to immunosuppression, which increases the risk of infections and other complications. This is a significant concern, especially in a young patient like yourself who wishes to maintain a good quality of life.

Weighing Risks and Benefits
When considering treatment options, it is crucial to discuss the potential risks and benefits with your healthcare provider. Here are some factors to consider:
1. Frequency of Relapses: If you have a history of frequent relapses, the benefits of using a biologic agent may outweigh the risks associated with immunosuppression. These medications can significantly reduce the likelihood of future attacks.

2. Severity of Previous Attacks: If your previous attacks have resulted in significant disability or complications, a more aggressive treatment approach may be warranted.

3. Overall Health: Your general health and any underlying conditions should also be taken into account. If you have a history of infections or other health issues, this may influence the decision to use immunosuppressive therapies.

4. Monitoring: If you choose to go with a biologic treatment, regular monitoring for infections and other side effects will be essential. This can help mitigate risks and allow for timely intervention if complications arise.

5. Quality of Life: Ultimately, the goal of treatment is to improve your quality of life. Discuss with your doctor how each treatment option aligns with your personal goals and lifestyle.

Conclusion
In summary, managing NMO requires a careful balance between controlling the disease and minimizing side effects. Corticosteroids are effective for acute management, but long-term strategies may involve immunosuppressive therapies, including biologics. It is essential to have an open dialogue with your healthcare provider to tailor a treatment plan that best suits your needs and preferences. Regular follow-ups and monitoring will be crucial in ensuring the effectiveness of the chosen therapy while minimizing potential risks. Your proactive approach in seeking treatment and understanding your condition will serve you well in navigating this challenging journey.

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