What factors influence whether you treat a suspected flare of NMOSD (neuromyelitis optica spectrum disorder) with pulse dose steroids versus plasmaphereis?   

I almost always begin with high-dose IV steroids but have a low threshold for layering on plasmapheresis. The two can be given concurrently. Thus, particularly for patients with myelitis/brainstem syndromes or those who have not begun to improve with a few days of steroids, I may consider adding pla...