Nöromyelitis Optika ve Tedavisi
Özet
Nöromyelitis optika spektrum bozukluğu (NMOSD), optik sinirleri ve spinal kordu öncelikli olarak etkileyen, merkezi sinir sisteminin nadir ve antikor aracılı otoimmün bir hastalığıdır. Bu bölüm, hastalığın tarihsel gelişiminden başlayarak epidemiyolojisini, akuaporin-4 (AQP4) antikorlarının rolüne odaklanan immünopatogenezini ve klinik sunumlarını detaylandırmaktadır. Özellikle 2015 Uluslararası Konsensüs Tanı Kriterleri ışığında AQP4-IgG pozitif ve negatif olguların yönetimi, karakteristik görüntüleme bulguları ve Multipl Skleroz (MS) ile olan ayırıcı tanısı üzerinde durulmuştur. Bölümün odak noktası güncel tedavi stratejileridir. Akut atak yönetiminde kullanılan yüksek doz kortikosteroidler ve plazma değişiminin (plazmaferez) yanı sıra, uzun vadeli atak önleyici tedaviler kapsamlıca incelenmiştir. Klasik immünosüpresanlardan (azatioprin, mikofenolat mofetil), hastalığın seyrini değiştiren ve son yıllarda onay alan yeni nesil monoklonal antikorlara (rituksimab, ekulizumab, inebilizumab, satralizumab ve ravulizumab) kadar geniş bir yelpazedeki tedavi seçeneklerinin etkinlikleri, güvenlik profilleri ve etki mekanizmaları güncel literatür verileri eşliğinde sunulmaktadır.
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