Anti-tuberculosis treatment for Devic’s neuromyelitis optica

There are no specific treatments for patients with acute, severe neurological deficits caused by neuromyelitis optica (NMO) who fail to recover after treatment with high-dose corticosteroids. We evaluated the clinical response of anti-tuberculosis treatment (ATT) in patients suffering from steroid-refractory NMO, and investigated the correlation between NMO and tuberculous infection of the central nervous system (CNS). We conducted this prospective, controlled study in southern China. Twelve patients with steroid-refractory NMO were monitored during ATT and compared with a control group of 13 patients with the same type of NMO who received current standard therapies. A molecular diagnostic test was carried out and Extended Disability Status Scale (EDSS) score analysis, visual acuity, the number of relapses and MRI changes were evaluated at study entry and after 1 and 2 years of therapy. ATT may lead to the recovery of important neurological functions and all our patients responded positively to therapy. EDSS score and visual acuity improved and abnormalities in the spinal cord, observed by MRI, markedly decreased over time. ATT also significantly reduced the rate of relapse. By comparison, in the control group, a significant clinical deterioration was observed, and patients did not show favourable EDSS scores and MRI changes. This study suggests that CNS infection with Mycobacterium tuberculosis is an important cause of NMO.