Is There A Surgery For Neuromyelitis Optica?

Neuromyelitis optica being an autoimmune disorder with demyelination as its characteristic presents as loss of vision as its chief symptoms with loss of sensations and other features of spinal cord damage. Autoimmune, for example, are generally very difficult to treat because of the fact that own immune system has started to attack, cells and if the immune system is to be destroyed then the other opportunistic infections would make their way into the body and it will cause fatality much earlier than the supposed time lapse in the autoimmune disorder like neuromyelitis optica.

As far as the research available for the neuromyelitis optica is concerned and the treatment modalities that have been found for it, there is no specific surgical treatment available for the disorder, in fact, there is also no definitive medical treatment available for it.^[1] In fact, the surgical the can prove more detrimental to the patient it will open up the inflammation process to the body and expose more amount of antigens to one’s own immune system which will flare up the severity and progression of the disease. Once diagnosed, it is an incurable disease with high morbidity.

Medical treatment is only given to downgrade the intensity of disease progression and to relieve the symptoms temporarily till the drugs are continued. Few surgical modalities can only have when it is associated with some other symptom like glaucoma, etc. If the disorder is associated with optic disc defects then it can be restricted with the help of laser treatment for the same.

Medical treatment is the only treatment modality to be found effective to an extent in the control of neuromyelitis optica. Intravenous corticosteroids are the drugs of choice and the first-line treatment for neuromyelitis optica. High dose synthetic corticosteroids like methylprednisolone are the most commonly used medicines in the various regimens.^[2] The act by the mechanism of reducing the inflammation to the antigens by the suppression of the immune system. The proliferation of the cells of the immune system is downgraded and the response to the antigenic stimulation is decreased. It also works by reducing the capillary permeability around the site of inflammation which results in lesser polymorphonuclear lymphocytes reaching to the site and blowing off of the inflammation.

Other various antilymphocyte medications have been used in its treatment, for example, mycophenolate mofetil, azathioprine, cyclosporine, methotrexate, rituximab first-line, etc. to name a few. In recent studies, mycophenolate mofetil and azathioprine have shown promise in the remission of neuromyelitis optica.^[3]

One other therapy which could be used with quite a success is plasmapheresis. In this therapy, the blood of the patient is taken out by a continuous working machine like the way in dialysis and is filtered for the removal of specific antibodies against the optic nerve and spinal cord antigens. When these antibodies get removed from the blood, the blood is infused back in the body. It not only is better than medical treatment in providing remission but also it delays the progression of the disease but the main disadvantage is invasive nature and repetitiveness of it for the continuous removal of the antibodies.

Conclusion

Being an autoimmune disorder, neuromyelitis optica has no specific treatment like the other autoimmune disorders which good completely cure the disease. Only the progression and severity can be downgraded with the usage of high dose corticosteroids in oral and intravenous forms. Surgical treatment is of no use in it, in fact, it can prove detrimental to the patient because it increases the exposure of the immune system towards the causative antigen and flares up the immune response against it, and so it is a contraindication.

Definite medical treatment is also not available but the disorder could be well controlled and relapse can be prevented if the early detection is possible and diagnosis is made before high titers of the antibodies developed against the causative antigens.

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Is There A Surgery For Neuromyelitis Optica?