ANALYSIS OF NEUROMYELITIS OPTICA RELAPSE IN NATIONAL HOSPITAL

CIPTO MANGUNKUSUMO JAKARTA INDONESIA

NovieDiyahNuraini*, YuhyiFajrina*, RiwantiEstiasari*
*Department of Neurology, Faculty of Medicine University of Indonesia

Background: Neuromyelitisoptica (NMO) is severe demyelinating disease of central nervous

system. Effective immunosupression is the standard of care for relapse prevention
Objective: To analyse relapse rate in NMO Patient
Methods: The study was conducted on patients registered with the diagnosis of NMO at the
National Hospital Cipto Mangunkusumo (NHCM), Jakarta, Indonesia in the period of January
2014 Juni 2016. We performed a retrospective, analysis of relapses in patient treated with
immunosupression.
Results: There were 21 patients with NMO. Eighteen patients got Azathioprine as long term
therapy, two patient die before initial treatment and one patient has tuberculosis treatment.
Thirteen (72% ) patient has no relaps after got azathioprine treatment The median duration of
treatment was 8 months (range,2-20 months). Two patient (11%) still have relapse after
treatment with azathioprine, with one of them has positive PCR CMV examination and has no
relapse after got antiviral treatment. One patient has bad compliance and got relapses one month
after stop the treatment. Two patient 1oss to followup. All patient got Methylprednisolon high
dose when relaps, and 5 (23%) patient also got plasmafaresis.
Conclusion: Relevance initial treatment with immunosupressiion significantly reduces relapse
rates in NMO. When relapses occurre with adequate treatment, we need further examination.
Infection assosiated with relapse occurance. Plasmafaresis and Methylprednisolone used as drug
of choice when relaps occur, and Azathioprine as drug of choice in long term therapy.
Insidensi relaps pada terapi dengan azathioprine dan tanpa azathioprine

tidak ada relaps : 11 (61 %)

Azathioprin
e : 18
ada relaps Clompiance baik : 1 (5%)

ada relaps compliance buruk : 2

loose to follow up : 2

sebelumnya menggunakan azathioprine, diganti

terapi CMV : 1 --> tidak ada relaps

tanpa
azathioprine
:3

dalam terapi TB : 1 --> terdapat relaps setelah

9 bulan remisi

meninggal : 2
 Klinis_saat_Onset

Frequency Percent Valid Percent Cumulative Percent

visual loss 9 45.0 45.0 45.0

Valid myelitis 11 55.0 55.0 100.0

Total 20 100.0 100.0

MRI_kepala

Frequency Percent Valid Percent Cumulative

Percent

Normal 12 60.0 80.0 80.0

Valid Tidak normal 3 15.0 20.0 100.0

Total 15 75.0 100.0

Missing System 5 25.0
Total 20 100.0

MRI_spine

Frequency Percent Valid Percent Cumulative

Percent

Normal 1 5.0 5.9 5.9

Valid Abnormal 16 80.0 94.1 100.0

Total 17 85.0 100.0

Missing System 3 15.0
Total 20 100.0

Location of Lesion in MRI_spine

Frequency

Cervical 8

Thoracall 1

Cervicothor
6
acal
 Not clear 4
Normal 1

EDSS

Frequency Percent Valid Percent Cumulative

Percent

1.00 1 5.0 5.3 5.3

3.00 2 10.0 10.5 15.8

4.00 3 15.0 15.8 31.6

7.00 8 40.0 42.1 73.7

Valid
8.00 2 10.0 10.5 84.2

9.00 1 5.0 5.3 89.5

9.50 2 10.0 10.5 100.0

Total 19 95.0 100.0

Missing System 1 5.0
Total 20 100.0