lacosamide and Neuromyelitis-Optica

Neuromyelitis optica spectrum disorders (NMOSD) are characterised by pathological antibodies to aquaporin-4 water channels of astrocytes, resulting in severe brain and spinal cord injury. Serological evidence suggests that Epstein-Barr virus (EBV) reactivation may contribute to their pathogenesis. We describe an unusual case of a woman with fever, rash and headache preceding an Aquaporin-4 antibody positive longitudinally extensive transverse myelitis. EBV was detected in her cerebrospinal fluid by polymerase chain reaction assay. This case highlights the potential role of EBV in the pathogenesis of NMOSD.

Topics: Adult; Aquaporin 4; Autoantibodies; Carbamazepine; Epstein-Barr Virus Infections; Female; Follow-Up Studies; Humans; Lacosamide; Neuromyelitis Optica

Paroxysmal tonic spasms [PTS] are common in patients with neuromyelitis optica spectrum disorder (NMOSD).1 2 In patients with demyelinating disease, PTS can significantly reduce the quality of life, limit activities of daily living and the rehabilitative process following an acute relapse 3. As in patients with multiple sclerosis (MS), paroxysmal tonic spasms in NMOSD usually respond well to treatment with carbamazepine.2 However, the optimal treatment in patients where carbamazepine is contraindicated or poorly tolerated is unclear. We describe a patient with NMOSD with severe paroxysmal tonic spasms who did not tolerate carbamazepine but was successfully treated with lacosamide (Vimpat).

Topics: Acetamides; Adult; Anticonvulsants; Carbamazepine; Female; Humans; Lacosamide; Neuromyelitis Optica; Spasm; Treatment Outcome

Topics: Acetamides; Carbamazepine; Humans; Lacosamide; Neuromyelitis Optica