Treatment for rare neuro-immunologic disorders (Transverse Myelitis, Acute Disseminated Encephalomyelitis, Neuromyelitis Optica and Optic Neuritis) in their acute or early stages involves quieting down the immune system as quickly as possible, before damage is done. These treatments need to be considered in the context of the correct diagnosis and administered as quickly as possible. Time is critical.
Unfortunately, there is very little research and almost no scientific evidence available as to the most effective treatments for any one of these disorders. It is important to be working with a physician who has good experience with these disorders, because acute treatment is going to involve primarily or exclusively clinical judgment. There are very few clinical centers with physicians who specialize in TM or NMO (e.g., University of Texas Southwestern, Johns Hopkins, Mayo Clinic, University of California San Francisco, Walton Centre – Liverpool, England), but there are numerous Multiple Sclerosis Centers associated with prominent medical centers and medical schools. A specialist from one of these centers should be considered, as they have experience in demyelinating disorders of the central nervous system.
The acute therapies most frequently used to treat an inflammatory attack include: high dose intravenous steroids (methylprednisolone), Plasmapheresis (Plasma Exchange or PLEX), Immunoglobulin Therapy (IVIG), and cyclophosphamide.
Treating Acute Inflammation (presentation from the 2010 Rare Neuroimmunologic Disorders Symposium) – Dean Wingerchuk, MD, Mayo Clinic
For specific information on acute treatments on each of the disorders, please click on the links below.