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December 21, 2015: Treatment of pediatric-onset neuromyelitis optica

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December 21, 2015

Treatment of pediatric-onset neuromyelitis optica

Neuromyelitis optica (NMO) is an inflammatory disorder of the central nervous system with symptoms manifesting from demyelination of the optic nerve and myelitis. The disorder can present in adults and less commonly in children. While acute exacerbations in NMO are treated with corticosteroids or plamsapharesis, preventive therapy in children is debated. Though, there is increasing evidence for the use of rituximab as a first-line therapy. Rituximab is a monoclonal antibody against CD-20 that decreases circulating B-cells. Small case series demonstrate over an 80% improvement in disease course and relapse rate in pediatric patients with NMO treated with rituximab, providing class IV evidence for its use in this disorder. Lemmers RJ, van der Vliet PJ, Klooster R, et al. A unifying genetic model for facioscapulohumeral muscular dystrophy. Science 2010; 329: 1650-1653.

  1. Longoni G, Banwell B, Filippi M, Yeh EA. Rituximab as a first-line preventive treatment in pediatric NMOSDs. Neurol Neuroimmunol Neuroinflamm 2014; 1: e46.
  2. Beres SJ, Graves J, Waubant E. Rituximab use in pediatric central demyelinating disease. Ped Neurol 2014; 51: 114-118.

Submitted by Adam Numis, MD, University of California, Los Angeles.

Disclosures: Dr. Numis is a member of the Resident and Fellow Section of Neurology.

For more clinical pearls and other articles of interest to neurology trainees, visit Neurology. Listen to this week's Neurology Podcast.

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