Dean Wingerchuk, MD – Mayo Clinic:
I think it’s helpful to consider different types of therapy for NMO in different categories. For example, there’s treatment of individual attacks, treatment and prevention of relapses and then treatment of symptoms. When a person has an attack of NMO most of the time treatment is with steroids, IV infusions of steroids and sometimes with a treatment called plasma exchange which is meant to filter the plasma, the liquid part of blood and presumably remove antibodies and other factors that were causing the relapse and improving the person’s function.
That secondary of treatment, which is prevention is extremely important in NMO, because we think that by successfully preventing relapses or attacks, we should be able to keep people stable and even give them a chance to improve from any damage that was done from their prior attacks. Currently most therapies for neuromyelitis optica that are preventative in nature are immune suppressants.
They’re meant to target some arm of the immune system that we think is causing damage in NMO, especially the antibody that’s associated with the disease and there are different types of therapies that appear to be able to do that. These include IV therapies such as rituximab and oral immune suppressant agents, such as azathioprine or mycophenolate.
None of these treatments have been approved by the FDA, but based on experience and collections of series from different hospitals throughout the world, we have a pretty good idea that these medications do make a difference. The third area of treatment is treatment of symptoms. So this could be visual loss, weakness, spasticity, or bladder problems, and these can be treated at any time during the illness, whether it’s in the context of a relapse or after the relapse has recovered.
