Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-28T01:35:45.906Z Has data issue: false hasContentIssue false
  • English
  • Français

Devic's Neuromyelitis Optica Treated with Intravenous Gamma Globulin (IVIG)

Published online by Cambridge University Press:  16 February 2016

Jacqueline Bakker  and
Luanne Metz
Jacqueline Bakker
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
Luanne Metz*
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
*
Department of Clinical Neurosciences, Foothills Medical Center, Multiple Sclerosis Clinic, Main Floor SSB, 1403-29th Street NW, Calgary, AB, T2N 2T9, Canada.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Devic's syndrome is a demyelinating disease of the spinal cord and optic nerves. It tends to have a poor prognosis, probably due to the occurrence of necrosis within lesions. There is no proven effective treatment although relapses are commonly treated with corticosteroids and people with recurrent attacks may be managed with chronic immune suppressing treatments. Intravenous gamma globulin (IVIG) and plasma exchange are reasonable treatment options because Devic's syndrome is believed to be antibody mediated. We report two patients of Devic's syndrome that stabilized following initiation of monthly IVIG.

Patient 1:

A 42-year-old woman with a 23 year history of Devic's syndrome continued to have frequent attacks of optic neuritis unresponsive to daily corticosteroids and azathioprine. Since initiation of monthly IVIG 5/2 years ago she has had no further definite attacks. She has also noted minimal improvement in color perception.

Patient 2:

A 58-year-old woman with a three year history of Devic's syndrome experienced five attacks during the first 16 months of disease. Monthly IVIG was associated with complete cessation of relapses and significantly improved neurological status over one year of treatment.

Conclusions:

Because active Devic's disease often results in severe, permanent neurological impairment, preventive intervention should be considered. These cases suggest that IVIG may be effective in preventing attacks and possibly in enhancing neurological recovery. Randomized controlled trials will be needed to confirm this and to determine optimal dosing and treatment duration.

Type
Case Report
Information
Canadian Journal of Neurological Sciences , Volume 31 , Issue 2 , May 2004 , pp. 265 - 267
Copyright
Copyright © The Canadian Journal of Neurological 2004

References

1.Wingerchuk, DM, Hogancamp, WF, O’Brien, PC, Weinshenker, BG. The clinical course of neuromyelitis optica (Devic’s syndrome). Neurology 1999;53:1107–1114.CrossRefGoogle ScholarPubMed
2.O’Riordan, JI, Gallagher, HL, Thompson, AJ, et al. Clinical, CSF, and MRI findings in Devic’s neuromyelitis optica. J Neurol Neurosurg Psychiatry 1996; 60:382–387.CrossRefGoogle ScholarPubMed
3.Mandler, RN, Davis, LE, Jeffrey, DR, Kornfeld, M. Devic’s neuromyelitis optica: a clinicopathological study of 8 patients. Ann Neurol 1993;34:162–168.CrossRefGoogle ScholarPubMed
4.Filippi, M, Rocca, MA, Moiola, L, et al. MRI and magnetization transfer imaging changes in the brain and cervical cord of patients with Devic’s neuromyelitis optica. Neurology 1999;53:1705–1710.CrossRefGoogle ScholarPubMed
5.Luccinetti, CF, Mandler, RN, McGavern, D, et al. A role for humoral mechanisms in the pathogenesis of Devic’s neuromyelitis optica. Brain 2002; 125: 1450–1461.CrossRefGoogle Scholar
6.Mandler, RN, Ahmed, W, Dencoff, JE. Devic’s neuromyelitis optica: a prospective study of seven patients treated with prednisone and azathioprine. Neurology 1998;51(4):1219–1220.CrossRefGoogle ScholarPubMed
7.Lennon, VA, Lucchinetti, CF, Weinshenker, BG. Identification of a marker autoantibody of neuromyelitis optica [abstract]. Neurology 2003; 60:5 (Suppl 1): A519.Google Scholar
8.Van Engelen, BG, Miller, DJ, Pavelko, KD, Hommes, OR, Rodriguez, M. Promotion of remyelination by polyclonal immunoglobulin in Theiler’s virus-induced demyelination and in multiple sclerosis. J Neurol Neurosurg Psychiatry 1994;57(Suppl):65–68.CrossRefGoogle ScholarPubMed
9.Lucchinetti, CF, Bruck, W, Rodriguez, M, Lassman, H. Distinct patterns of multiple sclerosis pathology indicate heterogeneity on pathogenesis. Brain Pathol 1996;6(3):259–274.CrossRefGoogle ScholarPubMed