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Emily SterryMr. KerkmanResearch Methods B2October 9, 2017The failure to Cure Neuromyelitis Optica Autoimmune Disease.Fun fact, another word for Neuromyelitis Optica is Devics syndrome. Neuromyelitis Optica Autoimmune disease is a rare disease of the central nervous system. This disease invades the optic nerve and spinal cord. The condition attacks the body’s immune system cells that uses good cells to identify viruses or infections, however with this disease these cells become ‘confused’. NMO shows up in all ages, from childhood to adulthood. People diagnosed with this sickness have to mentally prepare themselves for a long road of doctor appointments and medications.  Neuromyelitis Optica Autoimmune disease, also known as Devic’s, is a rare yet severe demyelinating disease, and has a long  history but if treated properly can suppress its effects greatly. The history of Neuromyelitis Optica Autoimmune disease has an interesting back story and present day status. This disease causes the immune system to destroy the tissues and organs of its own body; then causes inflammation on specific nerves, like the optic nerve and spinal cord. Due to the destroying of tissues and organs of one’s own body, this reslults in temporary or permanent damage.Furthermore, NMO is an autoimmune disease that attacks the myelin in your spine and optic nerve. Scientists at the University of Florida confirmed “Neuromyelitis Optica (NMO) and NMO Spectrum Disorder (NMOSD), also known as Devic’s disease, is an autoimmune disorder in which immune system cells and antibodies primarily attack the optic nerves and the spinal cord, but may also attack the brain” (“National Multiple Sclerosis Society”). This effect is commonly seen in patients carrying this disease.  NMO does appear in all ages, but typically shows up in between ages forty and fifty. NMO appears in two groups, the relapsing form usually appears in women with a ratio of four to one (Guthy). Another type of NMO is the monophasic, which means only one attack, but is very severe, often lasting one or two months and impacts men and women equally (Guthy). Dr. Dean Wingerchuk, from the International Panel of Neuromyelitis Optica Diagnosis strongly defended, “Historically, NMO was diagnosed with patients who experienced a rapid onset of blindness in one or both eyes, followed within days or weeks by varying degrees of paralysis in arms and legs” (Wingerchuk). When a patient relapses, new damage accumulates to the spinal cord or optic nerve increasing the chances of forming a disability (“National Multiple Sclerosis Society”). Preventing attacks and getting diagnosed at an early stage is necessary to the patient’s life, although  the cause to this disease remains unknown (Guthy).There is common misconception that Multiple Sclerosis and Neuromyelitis Optica are the same, but in reality they aren’t.  Dr. Brian Weinshenker, head of the U.S. Department of Health & Human Services declared, “MS and NMO used to be considered the same thing due to attacks in the same area, but recently has been proven to be separate diseases” (Weinshenker). The key symptoms that distinguish an NMO patient are uncontrollable hiccups and vomiting due to certain brainstem activity (Guthy). Prior to the misdiagnosis to many people, technology has evolved in the departments of laboratory testing, and special imaging allowing people to be diagnosed properly (Guthy). Additionally, NMO attacks tend be more severe than MS attacks. In MS, attacks usually are less intense letting the patient recover more easily (Guthy). “NMO rarely has a secondary progressive stage as in MS; disabilities accumulate from repeated acute attacks” (“National Multiple Sclerosis Society”). Also, NMO is considered to be an autoimmune disease because the immune system targets healthy tissues and organs as if it was a foreign; MS                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      doesn’t have a specific immune target to be classified, leading experts to result to MS cannot be categorized as an autoimmune disease (“National Multiple Sclerosis Society”).Following into the failure to medicate with the correct medication may increase the possibility of long-lasting harm. Azathioprine, Mycophenolate, and  Rituximab are all three very strong immunosuppressive drugs each carrying their own flaw. All three coming in a different form from a tablet, capsule, injection, or infusion along with a very different price range as well.Azathioprine as affirmed previously is an immunosuppressive medication, originally made in 1957. The cost for an Azathioprine tablet that’s fifty milligrams runs about three- hundred, eighty-six dollars, and sixty-eight cents, for a supply of five hundred tablets  (Wingerchuk). Kluwer Wolters, partnered with Clinical Drug Information and the American Pharmacists Association (APhA)  stated, “Patients while undergoing this treatment reduced the relapse rate by seventy-two percent with a fifty-three percent failure rate” (“Kluwer Wolters”). Concluding, Azathioprine carries a failure rate over half of the success rate. “Also, in some cases people using azathioprine have developed a rare fast-growing lymphoma cancer” (“Kluwer Wolters”). Patients who have developed this cancer have their spleen, bone marrow, or in severe cases their liver affected (“Kluwer Wolters”). Azathioprine can also cause viral infection in the brain that may event in disability, or even death.  To add, Mycophenolate was found in 1893, coming in tablet, capsule, or injection form.  Mycophenolate is taken twice a day with food. Typically higher doses are taken as the tablet form instead of the capsules (“Kluwer Wolters”). This drug typically costs three-hundred and thirty five dollars for a supply (“Kluwer Wolters”).  One of the major fallbacks from this treatment is that it doesn’t work immediately; this drug may take up to three months before any noticeable change (“Kluwer Wolters”). Dr. Dean M. Wingerchuk; neurologist at the Mayo clinic firmly expressed,  “Mycophenolate reduced the relapse rate up to eighty-seven point four percent with a thirty-six percent relapse rate” (Wingerchuk). Twenty-eight patients were medicated with mycophenolate, and sixty-four were relapse free. (Wingerchuk).  “Mycophenolate may affect your blood count putting the patient prescribed with this medication at risk to develop infections easier” (“Kluwer Wolters”). Confirmed by Kluwer Wolters, connected with The Canadian Pharmacists Association. Mycophenolate carries a higher chance of infection, Mycophenolate lowers the strength of common vaccinations (“Kluwer Wolters”).  Mycophenolate did improve in the relapse free rate, but still has some major setbacks, such as the medication taking up to three months to show any relief, an increase of infection, and a higher chance immunizations won’t work as well or at all.The last medication used to treat NMO is Rituximab. It is an infusion that can last up to 10 hours. Rituximab is only given in one form, infusion. The average cost for two infusions is about twenty-two thousand, five-hundred, and sixteen dollars (“Kluwer Wolters”). Families with no health insurance have little chance of receiving this treatment, because of its high expense. Patients with health insurance are not guaranteed to receive the infusion, either (Wingerchuk). The problem health insurance companies have are covering the full cost due to the high price. Dr. Rana Zabad part of the American Academy of Neurology, the American Medical Association, National MS Society asserted, if a patient does to get to try this treatment, the way an infusion is given is into the bloodstream by an IV, in hopes it will be completely effective (Zabad). After the infusion, reactions may occur within twenty-four hours of the treatment (Zabad). Patients with Cancer use Rituximab with chemotherapy, but patients with NMO do not use the chemo aspect (“Chemo Care”). “The amount of this medication you will receive depends on many other factors, including your height and weight, your general health or other health problems. Your doctor will determine your dosage and schedule” (“Chemo Care”).  Examples are: breathing difficulties, racing heart, chest pain, feeling faint, and fatigue (Zabad). In a study thirty patients were prescribed with Rituximab, ten patients (thirty-three percent) had one or more relapses, but twenty-two patients (sixty-seven percent) were relapse free (“Kluwer Wolters”).  “Rituximab reduced the rate by eighty- eight point two percent within two in three patients achieving complete remission” the author declared for the Guthy Jackson charitable foundation dedicated towards NMO (Guthy). Analyzed data shows effects after repeated treatments of Rituximab are suppressed, but very few patients get to experience this relief due to such a high cost. NMO can cause many life lasting effects on the body. With no known cause to this disease, and no cure, it is vital to get diagnosed as soon as possible. NMO is an intense, and severe disease. Its attacks  major parts of the body like, the optic nerve, spinal cord, or even the brain. An acute attack can still affect the body dramatically. One of the main spots Neuromyeltis optica attacks is the Optic Nerve. Also known as Optic Nerve Neuritis, this attack damages the eye or eyes and may be reversible or everlasting.  The President and CEO of the National Organization for Rare Disorders reports patients who develop this symptom tend to have vision loss, pain in the eye, flashing lights or flickering lights, and loss of color perception, even though it might not be noticeable (Saltonstall). These symptoms can develop over hours to days, but will take several weeks or even months for any sort of normality of the optic nerve to come forth (Guthy). When someone experiences Optic Nerve Neuritis they are treated with a steroid called corticosteroids (Guthy). Corticosteriods is used in massive amounts in IV to hopefully bring back some vision in the eye or eyes.  NORD is a patient advocacy organization dedicated to individuals with rare diseases and the organizations serving NORD declared, “Optic Nerve Neuritis disrupts the nerve fibers that sense vision info from your eye to your brain” (“NORD”). Allowing the disease to leave areas with broken down tissues (Saltonstall.)  The eye pain worsens by eye movement with some patients it feels like a dull ache behind the eye. Optic Nerve Neuritis visual field loss may happen in any pattern as well. (Wingerchuk).  In conclusion, Optic Nerve Neuritis can cause pain in the eye and vision loss.Between Optic Nerve Neuritis and Transverse Myelitis attack can be as long as several years. Dr. Rona Zabad, specialist at the University of Nebraska Medicine, is seen by patients from all over the world, and is a very reliable source and in her research she found:Transverse myelitis is an inflammation of the spinal cord, a major part of central nervous system.  The spinal cord carries nerve signals to and from the brain through nerves that extend from each side of the spinal cord and connect to nerves elsewhere in the body.  The term myelitis refers to inflammation of the spinal cord; transverse refers to the pattern of changes in sensation—there is often a band-like sensation across the trunk of the body, with sensory changes below. (Zabad)Michael Levis received the Lifetime Achievement Award from the American Academy of Hospice and Palliative Medicine (AAHPM) affirmed, “Transverse Myelitis (TM) is a disorder caused by inflammation of the spinal cord. It is characterized by symptoms and signs of neurologic dysfunction in motor and sensory tracts on both sides of the spinal cord” (Levis)  Patients experiencing Transverse Myelitis have symptoms along the lines of numbness, weakness, and paralyzation in the arms and legs (Guthy).  Sensory disturbance and loss of bladder control comes along with these symptoms. Professor Hillis serves as the Executive Vice Chair of Neurology, and Director of the Cerebrovascular Division defended: Many patients diagnosed with transverse myelitis will require rehabilitative care to prevent secondary complications of immobility and to improve their functional skills. It is important to begin therapy early during the course of recovery to prevent inactivity related problems (like skin breakdown and soft tissue contractures) that lead to loss of range of motion. (Hillis) The treatment for Transverse Myelitis after a relapse is plasmapheresis, removes antibodies from blood (Guthy). Transverse Myelitis causes damage to the myelin in your spine that may lead to loss of range and motion, numbness, weakness, or paralyzation. NMO a.k.a Devic’s disease, is an uncommon yet severe sickness, with no cause or cure. NMO is a demyelinating disease of the central nervous system. The disease attacks the optic nerve, spinal cord, and in rare cases the brain. The failure to cure Neuromyelitis Optica is due to many things. The first is the cause to the disease still remains unknown, leading to misdiagnosis between Multiple Sclerosis and Neuromyelitis Optica. Another reasoning is incorrect medication whether it be Mycophenolate, Azathioprine, or Rituxan each having its own major down fall. Then allowing the autoimmune disease to attack the body making the patient go into a relapse. Putting the body at risk for Optic Nerve Neuritis or Transverse Myelitis. Optic Nerve Neuritis is when the disease attacks the eye causing many problems that can result in permanent damage. Transverse Myelitis is when the sickness invades the spinal cord concluding with the possibility of paralyzation. In conclusion, the failure to cure Neuromyeltis Optice Autoimmune disease results in many things from misdiagnois, incorrect medicaiton leading to relapses, and no understanding of the cause. Sentence OutlineTopic: The failure to cure Neuromyelitis Optica Autoimmune Disease.Thesis: Neuromyelitis Optica Autoimmune disease, also known as Devic’s disease, is a rare yet severe demyelinating disease, with a long history but if treated properly can suppress its effects greatly.The history of Neuromyelitis Optica Autoimmune disease has an interesting back story and present day status.A  Furthermore, NMO is an autoimmune disease that attacks the myelin in your spine and optic nerve. B   There is common misconception that MS and NMO are the same thing, but in reality they aren’t.    II Following into the failure to medicate with the correct medication may increase the possibility of long-lasting harm. A Azathioprine as affirmed previously is an immunosuppressive medication, originally made in 1957. B   To add, Mycophenolate was found in 1893, coming in tablet, capsule, or injection form.  C   The last medication used to treat NMO is Rituximab.   III NMO can cause many life lasting effects on the body. A  One of the main three spots that NMO attacks is the Optic Nerve; also known as Optic Nerve Neuritis, causing damage to the eye or eyes that may be reversible or everlasting.   B  Between Optic Nerve Neuritis and Transverse Myelitis attack can be as long as several years. Work Cited “Chemo Care.” Cleveland Clinic Rituxan. Web. 15 Jan 2002″GARD.” Neuromyelitis Optica. Web. 5 Dec 2014″Guthy, Jackson.” Q&A about NMO with Brian Weinshenker, M.D. The Guthy- Jackson Charitable Foundation. Web April 2017Hopkins, John. “Neuromyelitis Optica.” US National LIbrary of Medicine National institutes of Health. Web 18 Aug 2016 Levis, Michael. Johns Hopkins Neuromyelitis Optica Clinic. Web. 22 Feb 2017″National Sclerosis Society.” Neuromyelitis Optica (NMO). Web. 24 May 2017Saltonstall, Peter. Neuromyelitis Optica. National Organization for Rare Diseases. Web. 20 Oct 2016Wingerchuk, Dr.Dean, and Dr.Brian Weinshenker. Neuromyelitis Optica , U.S. Department of Health & Human Services. Web. 2 Sept. 2015Wingerchuk, Dr.Dean, et al. “Research.”Guthy Jackson Charitable Foundation, The Guthy-Jackson Charitable Foundation. Web. 17 June 2017Zabad, Roana. College Of Medicine Department of Neurological Science. Web. 10 Jan. 2015(Will be last page of paper) Name ___________________________RESEARCH METHODS – MLA INFORMATIVE PAPER RUBRIC Introduction: Captures interest, follows hook, focus, thesis format Proper thesis at end of paragraph __________/5 ptsBody Section: Proper, sufficient documentation (7-11 pieces per body paragraph), at least 2 DQ’s per body paragraph well-developed mix of research and analysis, complete information, proper use of transition paragraphs, effective summary sentences, follows outline exactly, sentence outline done correctly, overall scope of paper is met __________/40 ptsConclusion: Restated thesis with transition, summary of main ideas, final impact statement to end paper, follows reasoning of paper __________/5 ptsWorks Cited: Every source cited in paper in Works Cited, every source listed in Works Cited is used at least once in parenthetical documentation, follows MLA guidelines exactly __________/15 ptsParenthetical No unnecessary duplication of parenthetical documentation,Documentation: sufficient and proper use of validations/lead ins, proper citation punctuation/information/spacing, at least one long quote formatted correctly, proper use of long quotes when required, parenthetical documentation utilized when needed __________/15 ptsMechanics: MLA format for headings/header, spacing, avoids unnecessary abbreviations/contractions/slang, punctuation, spelling, capitalization, proper and consistent verb tense, subject/verb agreement, grammar, no first person, no second person, MLA number rule, dates, italics, paragraphing __________/15 ptsStyle: Appropriate use of transitional words and phrases, sentence variety, improved word choice, no run ons or fragments __________/5 ptsTotal Score on Paper: (100 point grade x 2 = 200 total points for paper) __________/100 pts 10% penalty if turned in past due date/time (-10/100)

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