I am 34. How can I lower relapse risk in NMOSD?

Question

Hello doctor,

I am a 34-year-old woman who has experienced episodes of optic neuritis and myelitis. A recent magnetic resonance imaging (MRI) scan shows spinal cord lesions, and my aquaporin-4 (AQP4) antibody test came back positive. I am concerned about relapses and the possibility of long-term disability.

My neurologist has mentioned treatments such as Eculizumab and Rituximab as potential options.

Please tell me,

How do doctors decide on the most appropriate treatment?
What are the monitoring requirements for these therapies?
What lifestyle modifications may help reduce the risk of relapses?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and can understand your concern.

Your description is consistent with neuromyelitis optica spectrum disorder (NMOSD), especially with aquaporin-4 (AQP4) antibody positivity, which carries a high risk of recurrent relapses and long-term neurological disability if not effectively controlled.

The choice between therapies such as Eculizumab (complement inhibitor – monoclonal antibody) and Rituximab (anti-CD20 monoclonal antibody – B-cell depleting agent) depends on several factors, including availability, cost, frequency of administration, and your individual health profile.

Eculizumab (complement inhibitor – monoclonal antibody) has been shown to significantly reduce relapse risk. However, it requires intravenous infusions every two weeks and prior vaccination against meningococcal infection due to the increased susceptibility associated with complement blockade.

Rituximab (anti-CD20 monoclonal antibody – B-cell depleting agent) is also highly effective. It is generally given as infusions every six to twelve months, with monitoring of B-cell counts and immunoglobulin levels to guide retreatment.

Both treatments require regular blood tests and close vigilance for infections, and your neurologist will tailor the monitoring schedule to your needs. In addition to medication, lifestyle strategies can be helpful. These include avoiding infections through good hygiene and staying up to date with vaccinations, managing stress and fatigue, maintaining a balanced diet, and ensuring adequate sleep. These measures may help reduce the likelihood of triggering relapses.

It is also important to promptly report any new neurological symptoms for early evaluation and treatment.

Regular follow-up with your neurologist, adherence to prescribed therapy, and attention to overall health are key steps in lowering the risk of relapses and preserving long-term neurological function.

I hope this helps.

Thank you.