Anti-tuberculosis treatment for Devic's neuromyelitis optica

Area of Science:

• Neurology
• Infectious Diseases
• Immunology

Background:

• Neuromyelitis optica (NMO) is a severe autoimmune disorder affecting the central nervous system (CNS).
• Patients with acute, severe neurological deficits unresponsive to high-dose corticosteroids (steroid-refractory NMO) lack specific treatment options.
• The potential role of central nervous system (CNS) tuberculous infection in NMO pathogenesis remains under investigation.

Observation:

• A prospective, controlled study was conducted in southern China involving 12 patients with steroid-refractory NMO receiving anti-tuberculosis treatment (ATT).
• A control group of 13 patients with steroid-refractory NMO received standard therapies.
• Clinical response, neurological function (Extended Disability Status Scale - EDSS), visual acuity, relapse rates, and MRI changes were evaluated over two years.

Findings:

• Patients receiving ATT demonstrated significant recovery of neurological functions, improved EDSS scores, and enhanced visual acuity.
• MRI revealed marked decreases in spinal cord abnormalities over time in the ATT group.
• ATT significantly reduced the rate of NMO relapses, whereas the control group experienced clinical deterioration.

Implications:

• This study suggests that central nervous system (CNS) infection with Mycobacterium tuberculosis is a significant cause of neuromyelitis optica (NMO).
• Anti-tuberculosis treatment (ATT) may be a viable therapeutic strategy for steroid-refractory NMO, particularly in regions with high tuberculosis prevalence.
• Further research is warranted to elucidate the precise mechanisms linking tuberculous infection and NMO, and to validate ATT as a standard treatment.