Treatment of relapses in neuromyelitis optica spectrum disorders

Treatment of neuromyelitis optica spectrum disorders (NMOSD) relapses should be always urgent and consistent, because the majority of accumulation of neurological disability occurs just during relapses. The first-choice therapy is usually high-dose methylprednisolon followed by oral taper of steroids. In case of its failure elimination methods (therapeutic plasma exchange or immunoadsorption) are usually used. These methods can be also used as first choice therapy in case of severe relapse or if they had a positive effect on previous relapses in treated patient. In case of failure of elimination methods, administration of cyclophosphamid could be considered. Recently, several clinical trials with new drugs for acute relapses of NMO/NMOSD with highly specific mode of action have been conducted, however use of these drugs is still only experimental and its possible use in common clinical practice is awaited.