title: Immunoadsorption therapy for neuromyelitis optica spectrum disorders long after the acute phase.
abstract: Neuromyelitis optica (NMO) is a severe inflammatory demyelinating disease with exacerbations involving recurrent or bilateral optic neuritis and longitudinally extensive transverse myelitis. Pulse steroid therapy is recommended as the initial, acute-phase treatment for NMO. If ineffective, treatment with plasma exchange (PE) should commence. However, no evidence exists to support the effectiveness of PE long after the acute phase. Immunoadsorption therapy (IA) eliminates pathogenic antibodies while sparing other plasma proteins. With IA, side effects of PE resulting from protein substitution can be avoided. However, whether IA is effective for NMO remains unclear. We describe a patient with anti-aquaporin-4-positive myelitis who responded to IA using a tryptophan polyvinyl alcohol gel column that was begun 52 days after disease onset following the acute phase. Even long after the acute phase when symptoms appear to be stable, IA may be effective and should not be excluded as a treatment choice.
authors.affiliation: Department of Cardiology, Tokyo Medical University, Hachioji Medical Center, Tokyo, Japan.
authors.forename: Masatake
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Kazunori
authors.initials: K
authors.lastname: Nanri
authors.forename: Takeshi
authors.initials: T
authors.lastname: Taguchi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ishiko
authors.forename: Masaharu
authors.initials: M
authors.lastname: Yoshida
authors.forename: Noriko
authors.initials: N
authors.lastname: Yoshikawa
authors.forename: Kentaro
authors.initials: K
authors.lastname: Sugisaki
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Tanaka
mesh_terms: D000208:Acute Disease; D000328:Adult; D051401:Aquaporin 4 / Q000276:immunology; D001323:Autoantibodies / Q000097:blood / Q000302:isolation & purification; D002908:Chronic Disease; D006801:Humans; D007163:Immunosorbent Techniques; D008297:Male; D053580:Muscle Strength; D009471:Neuromyelitis Optica / Q000276:immunology* / Q000503:physiopathology / Q000628:therapy*; D010951:Plasma Exchange; D010956:Plasmapheresis; D013256:Steroids / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: C496030:AQP4 protein, human; D051401:Aquaporin 4; D001323:Autoantibodies; D013256:Steroids
keywords: neuromyelitis optica; plasmapheresis; steroid therapy