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There is currently no cure for NMOSD but there are treatment options for acute attacks, relapse prevention, and symptom relief.
Early treatment after an attack is essential to minimize the risk of permanent damage. The most common drugs are corticosteroids. High dose intravenous (IV; given through the vein) methylprednisolone is usually given over 3 to 5 days, followed by a slow tapering course of oral prednisolone.Plasma exchange (plasmapheresis) may be recommended as first or second treatment, especially for patients who did not respond substantially to corticosteroids. Plasma exchange involves removal of harmful antibodies and other immune factors in the blood stream by mechanically separating the blood cells from the fluid (plasma) via a specialized machine.
There are drugs available for the prevention of relapses. Your neurologist may recommend azathioprine, mycophenolate mofetil, rituximab, or tocilizumab. While these drugs have been demonstrated in small clinical trials, observation studies, and clinical practice to be effective in preventing NMOSD relapses and are commonly used, they are currently not approved by the U.S. Food and Drug Administration (FDA).Drugs which have been shown to be effective in reducing relapses in adults with NMOSD who have AQP4-IgG antibodies and are approved by the U.S. FDA include eculizumab, inebilizumab, and satralizumab. However, these monoclonal antibodies may not be readily available in every country.
After a relapse, people with NMOSD may continue to have symptoms such as weakness, walking difficulty, visual impairment, bowel and bladder issues, and pain. Medications can be prescribed to address these symptoms.Additionally, physiotherapy and occupational therapies are often required to optimize functional status e.g. to improve mobility.