Importance of Regular and Maintenance Therapy Adherence in Neuromyelitis Optica (NMO): Lessons from a Repeating Relapse Case
| Autor: | Boris Chulpayev, Doreen E Aboagye, Lin Liu, Gary Ishkanian, Dariush Alaie, Jing Miao, Bangaruraju Kolanuvada, Richard L. Petrillo |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Pediatrics medicine.medical_specialty Cyclohexanecarboxylic Acids Gabapentin Methylprednisolone 03 medical and health sciences 0302 clinical medicine Maintenance therapy Recurrence Prednisone Demyelinating disease medicine Humans Immunologic Factors Amines Glucocorticoids gamma-Aminobutyric Acid Autoantibodies Analgesics Neuromyelitis optica Plasma Exchange business.industry Neuromyelitis Optica Articles General Medicine Middle Aged Prognosis medicine.disease Treatment Adherence and Compliance Treatment Outcome 030104 developmental biology Hemiparesis Chronic Disease Female Rituximab medicine.symptom business Immunosuppressive Agents Biomarkers 030217 neurology & neurosurgery medicine.drug |
| Zdroj: | The American Journal of Case Reports |
| ISSN: | 1941-5923 |
| DOI: | 10.12659/ajcr.906150 |
| Popis: | Patient: Female, 58 Final Diagnosis: NMO Symptoms: New-onset right leg weakness and pain Medication: — Clinical Procedure: Progressive and recurring Specialty: Neurology Objective: Rare disease Background: Neuromyelitis optica (NMO) is a rare demyelinating disease of the central nervous system; NMO predominantly affects the spinal cord and optic nerves. The diagnosis is based on history, clinical presentation, seropositive NMO-IgG antibody, and notably, exclusion of other diseases. Despite the absence of definitive therapeutic strategies for NMO, methylprednisolone pulse therapy and plasma exchange are used for acute phase treatment, while immunosuppressive agent(s) are recommended to prevent relapses and improve prognosis. Here, we report a repeating relapse NMO case due to lack of regular and maintenance therapy. Case Report: A 58-year-old female with chronic NMO presented with a three-day history of new-onset right leg weakness and pain. The patient was diagnosed with NMO three years ago and presented with her fourth attacks. During her initial diagnosis, she was initiated on steroids. One year later, she developed the first relapse and was treated with steroids and rituximab, leading to 1.5-year remission. After the second relapse, steroids and rituximab was still given as maintenance therapy, but was not followed. Thus, the third relapse occurred in five months. During this hospitalization, she received initially high-dose solumedrol (1 g daily for five days) in addition to gabapentin 100 mg (gradually increased to 300 mg) three times a day for muscle spasms. Due to worsening of paresthesia and hemiparesis, it was decided to place her on plasma exchange treatment. After two plasma exchanges, the patient’s condition was improved and she regained strength in her lower extremity. She completed five more cycles of plasma exchange, and was then discharged on steroid therapy (prednisone 20 mg daily for 10 days then taper) as maintenance therapy and with follow-up in neurology clinic. Conclusions: Over the span of three years, the patient has had three relapses since her NMO diagnosis where her symptoms have worsened. Steroid therapy alone seemed not insufficient in managing her more recent relapses. Nonadherence to NMO treatment likely increased her risk for recurrence, thus regular and long-term maintenance therapy is imperative to delay the progression and prevent relapse in NMO. |
| Databáze: | OpenAIRE |
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