Successful Implementation of Modern Methods of Diagnosis and Treatment of Devic’s Disease in Neurologic Practice
The article provides brief information about neuromyelitis optica, or Devic’s disease, highlights the main aspects of the pathogenesis of this autoimmune pathology of the nervous system. Two clinical cases of this disease are described and analyzed in detail. In one of the cases, because of the atypical onset for neuromyelitis optica, disease was regarded as manifestation of viral radiculomyelitis, due to the presence of signs of general infectious syndrome in the clinical picture, as well as detection of antibodies to certain viruses in the cerebrospinal fluid. In the article, the authors give an interpretation of this finding, based on data from modern literature, which describes a possible correlation between the postponed infection of the central nervous system and the manifestation of Devic’s disease. The second clinical case shows a clinical picture of the onset of the disease with symptoms typical for neuromyelitis optica, which were initially mistakenly interpreted as manifestations of acute disturbances of both cerebral and spinal blood circulation, which indicates low awareness and alertness of practitioners in terms of neuromyelitis optica. Such onset led to the early diagnosis of the disease at the time of the patient’s administration at the Department of Neurology No. 1 of the Dnepropetrovsk Mechnikov’s Regional Clinical Hospital. The article demonstrated specific for this pathology radiological findings which were revealed in after performing of magnetic-resonance imaging of the spinal cord and brain, as well as a graphic image of the result of an immunological study. The role of indication of antibodies to aquaporin-4 is indicated, it is concluded that it is advisable to determine the titer of these antibodies not only in serum, but also in CSF. The main directions of the treatment tactics of Devic’s disease are considered, the use of monoclonal antibodies, in particular rituximab, as maintenance therapy, is justified. A detailed analysis of the data of clinical cases reflects the successful implementation of modern methods of diagnosis and treatment of this disease to the practice of the Department of Neurology No. 1 of the Dnepropetrovsk Mechnikov’s Regional Clinical Hospital.