Myelitis - Treatment

Treatment

Since each cases are different, the followings are possible treatments that patient might receive in the management of myelitis.

  • Intravenous Steroids

Receiving high-dose intravenous methyl-prednisolone for 3-5 days it is considered as a standard of care for patients suspected to have acute myelitis, unless there are compelling reasons not to. The decision to offer continued steroids or add a new treatment is often based on the clinical course and MRI appearance at the end of 5 days of steroids.

  • Plasma Exchange (PLEX)

Patients with moderate to aggressive forms of disease who don’t show much improvement after being treated with intravenous and oral steroids will be treated with PLEX. Retrospective studies of patients with TM treated with IV steroids followed by PLEX showed a positive outcome. It also has been shown to be effective with other autoimmune or inflammatory central nervous system disorders. Particular benefit has been shown with patients who are in the acute or subacute stage of the myelitis showing active inflammation on MRI. However, because of the risks implied by the lumbar puncture procedure, this intervention is determined by the treating physician on a case-by-case basis.

  • Immunosupressants/Immunomodulatory Agents

Myelitis with no definite cause seldom arises a recurrence, but for others, myelitis may be a manifestation of another diseases that are mentioned above. In these cases, ongoing treatment with medications that modulate or suppress immune system may be necessary. Or, sometimes there is no specific treatment. Either way, aggressive rehabilitation and long-term symptom management are an integral part of the healthcare plan.

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