[Severe bouts of neuromyelitis optica: dramatic improvement after plasma exchanges]

Area of Science:

• Neuroimmunology
• Neurology
• Demyelinating diseases

Background:

• Neuromyelitis optica (NMO) is a severe autoimmune demyelinating disease characterized by relapses.
• Corticosteroids are the first-line treatment for acute NMO relapses, but some cases are refractory.
• Plasma exchange (PE) is an extracorporeal treatment used for various neurological conditions.

Observation:

• Two patients with severe NMO relapses, one seropositive for NMO-IgG antibodies and one seronegative, were treated with PE.
• Both patients experienced significant improvement in both optical and spinal cord involvement following PE.

Findings:

• This case series suggests that plasma exchange (PE) can be highly effective in treating acute, severe neuromyelitis optica (NMO) relapses.
• The efficacy of PE appears independent of the presence or absence of NMO-specific antibodies (NMO-IgG).

Implications:

• Plasma exchange should be considered as a therapeutic option for refractory NMO relapses, irrespective of serological status.
• Further research is warranted to confirm these findings in larger cohorts and to elucidate the mechanisms of PE in NMO.