Managing NMOSD
The aims of current treatment options for neuromyelitis optica spectrum disorder (NMOSD) are to relieve symptoms of an acute attack and to prevent subsequent attacks (also known as relapses).1,2
Treating the symptoms that may linger following an attack can improve quality of life for patients.2,3 Such symptoms may include reduced vision, movement, bladder/bowel control, awareness and comprehension, as well as severe nausea or vomiting, tiredness, depression or pain.3,4
During an acute attack, parts of the nervous system become damaged, which can even lead to death of nerves and other cells in the nervous system.5,6 This can result in a build-up of tissue fluid and inflammation and further contributes to the nerve damage and the symptoms.6 That is why reducing this damage and suppressing the inflammation to preserve nerve function are the main goals in relieving acute attack symptoms.6
Treatment of an acute NMOSD attack usually starts with IV corticosteroids.6,7 The treatment is given by injection into a vein, usually once a day for about 3–5 days.5,6 This is commonly followed by decreasing doses of corticosteroids taken orally for a few weeks to months, depending on how severe the attack has been.5,6 The corticosteroids help to reduce the build-up of tissue fluid and inflammation at the site of nerve damage.6
If the healthcare professionals deem that not enough improvement has been observed with IV corticosteroids, plasma exchange may be performed.2,7 This involves insertion of a needle into a vein in each arm while resting on a reclining bed or chair.8 A machine will then draw out blood from one arm, separate the liquid part of the blood – the plasma – and with it, remove the harmful components of the blood, such as the abnormal antibodies and the proteins that are responsible for the inflammation.7–9 Replacement plasma is then returned together with the remaining parts of your blood via the other arm.8 A typical course of plasma exchange is 5–7 sessions every other day.7
If neither corticosteroids nor plasma exchange are suitable or available, immunoadsorption may be performed.2,7 The procedure is similar to plasma exchange, but there is greater control in which specific components and proteins are removed from the blood due to the use of a specific immunoadsorption device.7,9 With this, more parts of the blood, including specific proteins such as albumin, can be retained instead of discarded with the remaining plasma.9 Despite these differences, both immunoadsorption and plasma exchange seem to be equally effective.9
IV immunoglobulins are a pool of certain antibodies (immunoglobulins) collected from healthy donors,10 and they may occasionally be used as a treatment for acute NMOSD attacks when other options are unsuitable.7 The process involves injecting blood plasma – containing these antibodies – into a vein in the arm using an infusion pump. This procedure can often take several hours to complete.10
The main treatment currently used for preventing relapses in the long term for patients with NMOSD is immunosuppressive therapies.3,7 These drugs target components of the immune system to suppress the immune response, dampen inflammation and thus prevent disease relapse.7
