Guía de práctica clínica: tratamiento agudo de las enfermedades inflamatorio-desmielinizantes del sistema nervioso central: esclerosis múltiple, espectro de la neuromielitis óptica, encefalomielitis diseminada aguda, enfermedades asociadas a anticuerpos antiglicoproteína de la membrana del oligodendrocito, mielitis aguda y neuritis óptica. Elaborada por el Grupo de Trabajo de Enfermedades Desmielinizantes. Sociedad Neurológica Argentina

Abstract

Introduction

Adequate and timely treatment of acute manifestations of inflammatory-demyelinating diseases of the central nervous system including acute disseminated encephalomyelitis, isolated demyelinating syndromes (optic neuritis, acute myelitis), relapses of multiple sclerosis, neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein antibody-associated disease has implications for its prognosis. Each clinical scenario has its own particularity, and treatment has different degrees of evidence.

Objectives

To develop a clinical practice guideline on the acute treatment of inflammatory-demyelinating diseases of the central nervous system, based on the best available evidence.

Methods

A team to prepare the guidelines was formed among the members of the Working Group on Demyelinating Diseases of the Argentine Neurological Society. The methodology implemented was in accordance with the recommendations established by the Argentine Neurological Society, evidence-based, with its classification and elaboration of the recommendations according to the GRADE format.

Conclusions

We established 22 recommendations with different degrees and quality of evidence. High doses of intravenous corticosteroids are the first line of treatment in all cases, being able to use the oral route at equivalent doses in the relapses of multiple sclerosis and optic neuritis. It is recommended to use plasmapheresis in cases where there is insufficient response to steroids, mainly in neuromyelitis optica spectrum disorders, where indication should not be delayed and could be used as a first line treatment, although conclusive evidence is lacking. Other interventions generally lack sufficient evidence for their recommendation.