Concepts of Immune Therapy and Disease Management

Autoimmune inflammatory disorders are often marked by subacute development of new or worsening symptoms. These relapses reflect active inflammation and should be promptly recognized for early treatment and optimization of chronic immunomodulating or immunosuppressing therapies to avoid disability accumulation over time. Detection of subclinical activity using paraclinical testing also warrants a change in treatment and should be part of the monitoring approach of most disorders. Differentiating pseudorelapses or fluctuating symptoms from true relapses is important for appropriate management. Depending on the disease, oral or intravenous corticosteroids at low or high dosages, intravenous immunoglobulin, and plasmapheresis can be used to halt the inflammatory process and increase the chances of tissue recovery. Optimal symptom management is essential to improve functional outcomes and to complement the beneficial effect of long-term maintenance therapies. Management is limited by the lack of evidence-based guidelines for the monitoring and treatment of most disorders, with the exception of multiple sclerosis. Because of the difficulty to perform randomized controlled trials in autoimmune neurology, future work should aim at increasing knowledge from real-world cohorts and optimizing monitoring tools of disease activity.