Symptomatic and restorative therapies in neuromyelitis optica spectrum disorders

Abstract

Neuromyelitis optica spectrum disorders (NMOSD) are a group of autoimmune inflammatory conditions that primarily target the optic nerves, spinal cord, brainstem, and occasionally the cerebrum. NMOSD is characterized by recurrent attacks of visual, motor, and/or sensory dysfunction that often result in severe neurological deficits. In recent years, there has been a significant progress in relapse treatment and prevention but the residual disability per attack remains high. Although symptomatic and restorative research has been limited in NMOSD, some therapeutic approaches can be inferred from published case series and evidence from multiple sclerosis literature. In this review, we will discuss established and emerging therapeutic options for symptomatic treatment and restoration of function in NMOSD. We highlight NMOSD-specific considerations and identify potential areas for future research. The review covers pharmacologic, non-pharmacologic, and neuromodulatory approaches to neuropathic pain, tonic spasms, muscle tone abnormalities, sphincter dysfunction, motor and visual impairment, fatigue, sleep disorders, and neuropsychological symptoms. In addition, we briefly discuss remyelinating agents and mesenchymal stem cell transplantation in NMOSD.

Ultrasound-guided pulsed radiofrequency for neuromyelitis optica spectrum disorder-associated neuropathic pain: A case report

“…Unfortunately, as in the patient we reported, medication is often ineffective and has many side effects, such as dizziness, drowsiness, nausea, somnolence, and liver injury. [ 1 , 8 ] Nonpharmacological treatments for NMOSD-associated NP are being explored. Recently, a randomized controlled study showed that scrambler therapy can significantly alleviate NMOSD-associated NP, in which median NRS pain scores decreased from 5.0 to 1.5 within 10 days.…”

“…Neuromyelitis optica spectrum disorder (NMSOD) is an autoimmune disease of the central nervous system that causes multiple severe neurological deficits. [1][2][3] Neuropathic pain (NP), a common symptom of NMSOD, is often severe and intractable, [4][5][6] affecting more than 85% of patients, [5,7] and often resulting in a significant burden on the physical and mental health of patients, thus seriously reducing quality of life. [6,[8][9][10] At present, there is no standardized effective treatment for central NP caused by NMOSD.…”

Immune-Mediated Myelopathies

“…53 Neuropathic pain usually requires combined medical and nonmedical treatment approaches that serve to reduce, but not eliminate, the pain, which may subside over time. 54 Similarly, muscle spasms in previously weakened muscles are common during recovery. Treatment with muscle relaxants may help but can exacerbate weakness.…”

Neuromyelitis optica spectrum disorders: a review with a focus on children and adolescents

“…Muscle relaxants are used to treat spasticity and anticholinergics to treat neurogenic bladder. 22 53 …”

“…Muscle relaxants are used to treat spasticity and anticholinergics to treat neurogenic bladder. 22,53 Pediatric NMOSD In 1927, there was the first report of NMOSD in patients < 18 years old. It is possible that many cases described earlier were misdiagnosed as other demyelinating disorders, especially MS. 54 The International Pediatric Multiple Sclerosis Study Group (IPMSSG) published the pediatric diagnostic criteria for MS and related disorders in 2007 and revised them in 2013.…”