2014 Volume 31 Issue 1 Pages 5-12
Neuromyelitis optica has a lower prevalence than idiopathic optic neuritis,and tends to become refractory. Recently,the relationship between anti-aquaporin 4(AQP4)antibody and neuromyelitis optica has been elucidated,which has provided insight into the gradual clarification of therapeutic approaches. Anti-AQP4 antibody-positive optic neuritis has an acute onset,and is generally resistant to steroids,causing diverse visual changes. Astrocytes,which are one type of glial cells,are the target cells. A high female to male ratio(9 : 1)is also a characteristic. On the other hand,in anti-myelin oligodendrocyte glycoprotein(MOG)antibody-positive optic neuritis,oligodendrocytes are the target cells. Like anti-AQP4 antibody-positive optic neuritis,damages tend to extend from the optic nerve to the optic chiasm and optic tract,and therefore manifesting visual changes similar to those of anti-AQP4 antibody-positive optic neuritis. Although the prognosis of anti-MOG antibody-positive optic neuritis is relatively favorable,some patients respond poorly to high-dose steroid therapy and the disease tends to recur. Treatment for both anti-AQP4 antibody-positive and anti-MOG antibody-positive optic neuritis should start with pulse steroid therapy initially,and switch to plasmapheresis,immunoadsorption or high-dose immunoglobulin therapy when resistance develops.
