Th17-Related Cytokines as Potential Discriminatory Markers between Neuromyelitis Optica (Devic’s Disease) and Multiple Sclerosis—A Review

Multiple sclerosis (MS) and Devic’s disease (NMO; neuromyelitis optica) are autoimmune, inflammatory diseases of the central nervous system (CNS), the etiology of which remains unclear. It is a serious limitation in the treatment of these diseases. The resemblance of the clinical pictures of these two conditions generates a partial possibility of introducing similar treatment, but on the other hand, a high risk of misdiagnosis. Therefore, a better understanding and comparative characterization of the immunopathogenic mechanisms of each of these diseases are essential to improve their discriminatory diagnosis and more effective treatment. In this review, special attention is given to Th17 cells and Th17-related cytokines in the context of their potential usefulness as discriminatory markers for MS and NMO. The discussed results emphasize the role of Th17 immune response in both MS and NMO pathogenesis, which, however, cannot be considered without taking into account the broader perspective of immune response mechanisms.

Modern Methods of Devic’s Disease Treatment

BACKGROUND: Neuromyelitis optica (NMO) (also known as opticomyelitis, Devic’s syndrome/disease) is an idiopathic inflammatory disorder of the central nervous system characterized by predominant involvement of the optic nerves, spinal cord, and extensive transverse myelitis. To date, there are no convincing clinical trials that would fully evaluate the efficacy and safety of drugs for the treatment and prevention of NMO exacerbation. Taking into account the malignant course that quickly leads to disability of young, economically active population, the issues of searching for effective methods of NMO treatment remain highly urgent. AIM: The purpose of the study was to examine available modern methods of treatment and prevention of NMO exacerbation, which have potential and require further detailed clinical trials to ensure possible application of these treatment options in clinical practice. MATERIALS AND METHODS: We have reviewed previously applied and modern methods of treatment. We have analyzed systematic reviews, clinical, randomized, and retrospective studies of scientific medical databases: PubMed, Cochrane, The Lancet, UpToDate, and reviews of world medical journals in Russian and English. CONCLUSIONS: The authors concluded that there is a sufficient number of drugs and combinations of methods of Devic’s disease treatment. We were interested in combinations of rituximab (RIT) and autologous stem cell transplantation, RIT and fetal hepatocyte transplantation, and RIT and strengthening the effect by plasmapheresis sessions. However, successful implementation of these methods in clinical practice requires conducting controlled clinical trials with a larger number of patients and longer follow-up periods.

CASE REPORT-NEUROMYELITIS OPTICA/ DEVIC'S DISEASE: A RARE DISEASE

Neuromyelitis Optica spectrum disorder or Devic’s disease are autoimmune diseases that manifest clinically with 6 core symptoms, which include acute optic neuritis, transverse longitudinal segment myelitis, and acute brainstem syndrome.{1}Neuromyelitis optica is characterized by attacks of optic neuritis and longitudinally extensive transverse myelitis. It is often confused with multiple sclerosis. Early discrimination between NMO and MS is important because the two diseases have different natural histories and treatment regimens. Despite the absence of a definitive therapeutic strategy for NMO syndrome, methylprednisolone pulse therapy is recommended in acute phase. Treatment strategies in relapse phases are aimed at preventing relapses, and increasing evidences show a better clinical response of immunosuppressive therapy than immunomodulating therapy. We report a case of NMSOD in a patient of age 55 , with transverse myelopathy as the initial manifestation. The patient presented with acute gait disturbance and hypoesthesia in right lower limb since 10 days . After thorough physical examination and various lab investigations and imaging, the patient received high dose methylprednisolone. The patient’s serum was positive for anti-AQP4 antibodies .During the course of treatment , patient again presented with complaint of blurred vision in the ER after 1 year. Diagnosis of NMSOD was established. After combining methylprednisolone and immunosuppressant therapy , the patient’s medical condition was stable and relapses were prevented.