Perspectivas do uso de corticoterapia no tratamento do transtorno do espectro da neuromielite óptica: uma revisão integrativa da literatura

Abstract

Neuromyelitis optica spectrum disorder is a rare disease mediated by central nervous system antibodies. Long segments of spinal cord inflammation (myelitis), severe optic neuritis, and/or intractable bouts of vomiting and hiccups (area postrema syndrome) are classic presentations of the disease and may alert the clinician to the diagnosis. Until a few years ago it was unclear whether neuromyelitis optica was a separate disease or just a more severe form of optic-spinal multiple sclerosis (MS). It is usually caused by antibodies targeting aquaporin 4 (AQP4). However, NMO remains a potentially fatal and severely disabling condition that often requires immediate and consequential immunosuppressive treatment. Clinical decision making regarding diagnosis and initiation of treatment remains challenging, so testing for AQP4 antibody via a highly sensitive and highly specific assay may be essential. Treatment of neuromyelitis optica is divided into two phases – acute (or chronic) phase treatment and maintenance treatment. An integrative review was conducted in order to gather studies on the use of corticosteroids for the treatment of neuromyelitis optica. The literature search covered the period between 2017 and 2022, in the Lilacs, Medline/Pubmed and Scielo databases. Titles and abstracts were reviewed for relevance. The results presented 14 publications that analyzed the use of corticosteroid therapy in the treatment of neuromyelitis optica spectrum disorder. The use of corticosteroids showed promise when used more aggressively for the treatment of the acute phase and also when used as preventive therapy (in lower doses) to reduce the frequency of relapses.