title: [A treatment of neuromyelitis optica (Devic's disease) during pregnancy].
abstract: Neuromyelitis optica (Devic's disease) is an inflammatory demyelinating disease of the central nervous system that mainly affects spinal cord, optic nerve and brain regions with high aquaporin 4 antigen expression. This is a severe autoimmune disease caused by autoantibodies directed against aquaporin 4 and associated with high morbidity and mortality. Unlike other inflammatory conditions such as multiple sclerosis or rheumatoid polyarthritis, pregnancy does not seem to influence the activity of neuromyelitis optica, hence the need for a thorough treatment during pregnancy. Corticosteroid therapy is the treatment of choice for neuromyelitis optica during pregnancy. Other treatments may also be used including rituximab, some immunosuppressive agents and immunoglobulins. Immunosuppressive treatment or rituximab is recommended when the long-term corticosteroid treatment is contraindicated, in case of inefficiency or if side effects are intolerable. Immunoglobulins are administered to patients with serious outbreaks of neuromyelitis optica which do not respond to bolus methylprednisolone. Immunoglobulins alone can also be continued at a dose of 0.4 g/kg/day for 6-8 weeks until delivery. Plasmapheresis is also a good alternative to bolus methylprednisolone when outbreaks are extremely severe.
authors: Service de Neurologie, CHU Hassan II, Fès, Maroc.
authors: Moussa Toudou
authors: MT
authors: Daouda
authors: Service de Neurologie, CHU Hassan II, Fès, Maroc.
authors: Norlin Samuel
authors: NS
authors: Obenda
authors: Service de Médecine et Spécialités Médicales, Hôpital National de Niamey, Niger; Faculté des Sciences de la Santé, Université Abdou Moumouni de Niamey, Niger.
authors: Hamid
authors: H
authors: Assadeck
authors: Service de Neurologie, CHU Hassan II, Fès, Maroc.
authors: Diankanagbe
authors: D
authors: Camara
authors: Service de Médecine et Spécialités Médicales, Hôpital National de Niamey, Niger.
authors: Fatimata Hassane
authors: FH
authors: Djibo
mesh_terms: D051401:Aquaporin 4 / Q000276:immunology; D001323:Autoantibodies / Q000276:immunology; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009471:Neuromyelitis Optica / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D010956:Plasmapheresis / Q000379:methods; D011247:Pregnancy; D011248:Pregnancy Complications / Q000276:immunology / Q000473:pathology / Q000628:therapy*
chemical_list: D051401:Aquaporin 4; D001323:Autoantibodies; D005938:Glucocorticoids; D007166:Immunosuppressive Agents
keywords: Neuromyelitis optica and pregnancy; corticosteroid therapy; immunosuppressive agents and rituximab; intravenous immunoglobulins; plasmapheresis