12 Like corticosteroids and PLEX, there are no data confirming the value of IVIG in the setting of acute events. Reactions after an infusion can be more serious and include migraine headaches, aseptic meningitis, renal impairment and blood clots. Potential adverse reactions are uncommon, but usually occur during or immediately after an infusion and include headache, nausea, muscle pain, fever, chills, chest discomfort, skin and anaphylactic reactions. 11 As the name suggests, IVIG is given intravenously. Immunoglobulin comes from pooled blood that is donated from thousands of healthy people. Particular benefit has been shown if started within the acute or sub-acute stage of the myelitis or if there is continued active inflammation on MRI.Īnother option for treating anti-MOG associated acute inflammation is intravenous immunoglobulin (IVIG). Early treatment is beneficial – PLEX is typically started within days of administering steroids, very often before the course of steroids has finished. PLEX also has been shown to be effective in other autoimmune or inflammatory central nervous system disorders. There have been no prospective clinical trials that prove PLEX’s effectiveness in MOG antibody disease, but retrospective studies of TM treated with IV steroids followed by PLEX have shown a beneficial outcome. If presenting symptoms are severe, PLEX may be initiated concurrently with steroids. PLEX is often recommended for moderate to aggressive forms of TM and ON, as is very often the case with MOG antibody disease, if there is not much improvement after being treated with intravenous steroids. PLEX is believed to work in autoimmune CNS diseases through the removal of specific or nonspecific soluble factors likely to mediate, be responsible for, or contribute to inflammatory-mediated organ damage. 2,3 An oral steroid taper may be helpful to prevent steroid-withdrawal relapses. Those with MOG antibody disease seem to respond well to steroids. The decision to offer continued steroids or add a new treatment is often based on the clinical course and MRI appearance at the end of 5 days of steroids. The following are possible treatments in the management of an acute event.Īlthough there are no clinical trials that support a unique approach to treat patients with MOG antibody disease, it is well recognized as a standard of care to give high-dose intravenous methylprednisolone for suspected acute myelitis or optic neuritis, generally for 3 to 5 days, unless there are compelling reasons not to. Treatment guidelines for MOG antibody disease have not been established. Coaching Series on Relationships and Communication.COVID-19 and Rare Neuroimmune Disorders.
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