Egyptian Experience of Rituximab Use in Neuromyelitis Optica

Abstract

N euromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease of the central nervous system with preferential involvement in the optic nerve and spinal cord resulting in long-term disability from incomplete remission of attacks, thus prevention of further relapses is the goal of preventative immunotherapy such as rituximab in NMOSD. This study was conducted on 25 Egyptian adult patients diagnosed with NMOSD according to the 2015 international consensus diagnostic criteria and receiving rituximab treatment was recruited from the MS unit at the Neurology department in Ain Shams University hospital. Patients were subjected to clinical assessment including detailed medical history including: Age, gender, residency, risk factors, past history and family history suggesting autoimmune diseases, Detailed history of current illness (NMO) according to MS unit sheet Ain shams university hospital with special emphasis to onset of disease, presenting symptoms, disease progression and response to treatment, General examination and full neurological examination. Magnetic Resonance Imaging (MRI) of cervical cord, dorsal cord or brain (whether indicated) initial and follow after 12 months. Serum Aquaporin 4 Ab and Visual Evoked Potential, total number of relapses during the course of disease before starting rituximab treatment and Annual relapse rate (ARR) since starting rituximab use. Assessment of functional disability using Expended Disability Status Scale (EDSS). The EDSS is routinely done by the MS units’ consultants and specialists. The EDSS scores were obtained from the patients’ records throughout their illness namely the EDSS scores before and after one year from riruximab.