Devic's or PPMS?

by

Joe Chu, M.D.

How would you manage and treat a 28 yo woman who develops acute thoracic transverse myelitis (Power 3-/5 and sensory level at T5-6 with moderate bladder and bowel involvelment) and bilateral optic neuritis (color desaturation and reduced VA to 20/120)? She had not responded favourably to 2 courses of IV solumedrol pulses (1 gm daily for 3 days followed by po prednisone taper). There was no evidence of SLE, systemic vaculitis or CNS lymphoma during her workup. Her MRI of her thoracic spine showed a longtitudinal T2-hyperintense lesion from T2 to T5. CT brain normal but she awaits gad-MRI of her brain. I believe she has Devic's disease (neuromyelitis optica).

1. Treat with IVIG

2. Treat with PLEX

3. Treat with immunosuppressives such as azathiaprine, cyclophosphamide, or mycophenolate

Please support your answers with evidence.

Joe Chu
CANADA

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January 10, 2005

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