Tags

Type your tag names separated by a space and hit enter

Importance of Regular and Maintenance Therapy Adherence in Neuromyelitis Optica (NMO): Lessons from a Repeating Relapse Case.
Am J Case Rep 2018; 19:41-46AJ

Abstract

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.

Authors+Show Affiliations

Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA.Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA.Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA.Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA.Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA.Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA.Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA.Department of Internal Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY, USA.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

29321467

Citation

Miao, Jing, et al. "Importance of Regular and Maintenance Therapy Adherence in Neuromyelitis Optica (NMO): Lessons From a Repeating Relapse Case." The American Journal of Case Reports, vol. 19, 2018, pp. 41-46.
Miao J, Aboagye DE, Chulpayev B, et al. Importance of Regular and Maintenance Therapy Adherence in Neuromyelitis Optica (NMO): Lessons from a Repeating Relapse Case. Am J Case Rep. 2018;19:41-46.
Miao, J., Aboagye, D. E., Chulpayev, B., Liu, L., Ishkanian, G., Kolanuvada, B., ... Petrillo, R. L. (2018). Importance of Regular and Maintenance Therapy Adherence in Neuromyelitis Optica (NMO): Lessons from a Repeating Relapse Case. The American Journal of Case Reports, 19, pp. 41-46.
Miao J, et al. Importance of Regular and Maintenance Therapy Adherence in Neuromyelitis Optica (NMO): Lessons From a Repeating Relapse Case. Am J Case Rep. 2018 Jan 11;19:41-46. PubMed PMID: 29321467.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Importance of Regular and Maintenance Therapy Adherence in Neuromyelitis Optica (NMO): Lessons from a Repeating Relapse Case. AU - Miao,Jing, AU - Aboagye,Doreen E, AU - Chulpayev,Boris, AU - Liu,Lin, AU - Ishkanian,Gary, AU - Kolanuvada,Bangaruraju, AU - Alaie,Dariush, AU - Petrillo,Richard L, Y1 - 2018/01/11/ PY - 2018/1/12/entrez PY - 2018/1/13/pubmed PY - 2018/2/6/medline SP - 41 EP - 46 JF - The American journal of case reports JO - Am J Case Rep VL - 19 N2 - 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. SN - 1941-5923 UR - https://www.unboundmedicine.com/medline/citation/29321467/Importance_of_Regular_and_Maintenance_Therapy_Adherence_in_Neuromyelitis_Optica__NMO_:_Lessons_from_a_Repeating_Relapse_Case_ L2 - https://www.amjcaserep.com/download/index/idArt/906150 DB - PRIME DP - Unbound Medicine ER -