Neuromyelitis Optica - Diagnosis

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How is neuromyelitis optica diagnosed?

Historically, NMO was diagnosed in patients who experienced a rapid onset of blindness in one or both eyes, followed within days or weeks by varying degrees of paralysis in the arms and legs. In most cases, however, the interval between optic neuritis and transverse myelitis is significantly longer, sometimes as long as several years. After the initial attack, NMO follows an unpredictable course. Most individuals with the syndrome experience clusters of attacks months or years apart, followed by partial recovery during periods of remission. This relapsing form of NMO primarily affects women. The female to male ratio is greater than 4:1. Another form of NMO, in which an individual only has a single, severe attack extending over a month or two, is most likely a distinct disease that affects men and women with equal frequency. The onset of NMO varies from childhood to adulthood, with two peaks, one in childhood and the other in adults in their 40s.

In the past, NMO was considered to be a severe variant of multiple sclerosis (MS) because both can cause attacks of optic neuritis and myelitis. Recent discoveries, however, suggest it is a separate disease. NMO is different from MS in the severity of its attacks and its tendency to solely strike the optic nerves and spinal cord at the beginning of the disease. Symptoms outside of the optic nerves and spinal cord are rare, although certain symptoms, including uncontrollable vomiting and hiccups, are now recognized as relatively specific symptoms of NMO that are due to brainstem involvement.

The recent discovery of an antibody in the blood of individuals with NMO gives doctors a reliable biomarker to distinguish NMO from MS. The antibody, known as NMO-IgG, seems to be present in about 70 percent of those with NMO and is not found in people with MS or other similar conditions.

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Comment from: lupiecat95, 55-64 Female (Caregiver) Published: March 13

My mother had her first attack of Devic's disease (neuromyelitis optica) this past January at the age of 63. She was in ICU for several weeks. She was on a ventilator for 3 weeks, then had a tracheotomy and is now on a ventilator again as of 3/9/14. Hers started with vomiting, then hiccups. She had numbness of her legs and then she started having problems breathing. After several days of trying to diagnose her, my mentioning to her doctor that several family members had autoimmune disorders (her sister and I both have lupus), they started researching and found that she had Devic's. She was on mega-doses of steroids for about a week with very little change. Plasmapheresis helped her a lot more. She still can't feel her legs and has extreme weakness in her left arm. The weird thing is that she's not having problems with her vision (thank goodness). Her prognosis is a nursing home at least until they can remove the tracheotomy. I wish I could get her somewhere she could be treated by doctors who knew about this disease because her doctors had never heard of it.

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