- Neuromyelitis Optica (Devic's Syndrome) Center
- Dementia Slideshow Pictures
- Take the ADHD Quiz
- Brain Foods Slideshow
- Patient Comments: Neuromyelitis Optica - Experience
- Patient Comments: Neuromyelitis Optica - Symptoms
- Patient Comments: Neuromyelitis Optica - Treatment
- Patient Comments: Neuromyelitis Optica - Prognosis
- Patient Comments: Neuromyelitis Optica - Diagnosis
Neuromyelitis optica facts*
*Neuromyelitis optica facts medical author: Charles Patrick Davis, MD, PhD
- Neuromyelitis optica (NMO) is an uncommon disease of the central nervous system (CNS) that affects the optic nerves and spinal cord due to myelin loss.
- Symptoms include rapid onset of eye pain and vision loss, myelitis (muscle weakness), numbness, and occasionally paralysis of the arms and legs with sensory disturbances and loss of bowel and bladder control; some patients may exhibit vomiting and hiccups.
- Neuromyelitis optica is diagnosed mainly from the patient's history and physical exam. Recently, detection of an antibody termed NMO - IgG can help distinguish between neuromyelitis optica and multiple sclerosis.
- Treatment of neuromyelitis optica usually occurs with methylprednisone and an immunosuppressive drug (azathioprine). Plasmapheresis (plasma exchange) has also been used but there is no cure for this disease.
- Unfortunately, neuromyelitis optica patients have an unpredictable and relapsing course of disease. Damage and disability is slowly cumulative due to recurrent attacks that damage new areas of myelin. Most individuals are impaired from myelitis and also have reading difficulties.
- The National Institute of Neurological Disorders and Stroke (NINDS) is conducting research aimed at treating, preventing, and eventually curing this disease.
Quick GuideConcussions & Brain Injuries: Symptoms, Tests, Treatment
What is neuromyelitis optica?
Neuromyelitis optica (NMO) is an uncommon disease syndrome of the central nervous system (CNS) that affects the optic nerves and spinal cord.
What are the symptoms of neuromyelitis optica?
Individuals with NMO develop optic neuritis, which causes pain in the eye and vision loss, and transverse myelitis, which causes weakness, numbness, and sometimes paralysis of the arms and legs, along with sensory disturbances and loss of bladder and bowel control. NMO leads to loss of myelin, which is a fatty substance that surrounds nerve fibers and helps nerve signals move from cell to cell. The syndrome can also damage nerve fibers and leave areas of broken-down tissue. In the disease process of NMO, for reasons that aren't yet clear, immune system cells and antibodies attack and destroy myelin cells in the optic nerves and the spinal cord.
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.
What is the treatment for neuromyelitis optica?
There is no cure for NMO, but there are therapies to treat an attack while it is happening, to reduce symptoms, and to prevent relapses. Doctors usually treat an initial attack of NMO with a combination of a corticosteroid drug (methylprednisolone) to stop the attack, and an immunosuppressive drug (azathioprine) for prevention of subsequent attacks. If frequent relapses occur, some individuals may need to continue a low dose of steroids for longer periods. Plasma exchange (plasmapheresis) is a technique that separates antibodies out of the blood stream and is used with people who are unresponsive to corticosteroid therapy. Pain, stiffness, muscle spasms, and bladder and bowel control problems can be managed with the appropriate medications and therapies. Individuals with major disability will require the combined efforts of occupational therapists, physiotherapists, and social services professionals to address their complex rehabilitation needs.
What is the prognosis for neuromyelitis optica?
Most individuals with NMO have an unpredictable, relapsing course of disease with attacks occurring months or years apart. Disability is cumulative, the result of each attack damaging new areas of myelin. Some individuals are severely affected by NMO and can lose vision in both eyes and the use of their arms and legs. Most individuals experience a moderate degree of permanent limb weakness from myelitis. Muscle weakness can cause breathing difficulties and may require the use of artificial ventilation. The death of an individual with NMO is most often caused by respiratory complications from myelitis attacks.
What research is being done?
The National Institute of Neurological Disorders and Stroke (NINDS) conducts research related to NMO in laboratories at the NIH and also supports additional research through grants to major medical institutions across the country. Much of this research focuses on finding better ways to prevent, treat, and ultimately cure rare neurological syndromes such as NMO.
Brain and Nervous System Resources
Last update: 5/14/2010
"NINDS Neuromyelitis Optica Information Page." National Institute of Neurological Disorders and Stroke. 14 Feb. 2014.
Neuromyelitis Optica - Experience
Please describe your experience with neuromyelitis optica.Post View 9 Comments
Neuromyelitis Optica - Symptoms
What were the symptoms of your neuromyelitis optica?Post View 3 Comments
Neuromyelitis Optica - Treatment
What was the treatment for your neuromyelitis optica?Post View 2 Comments
Neuromyelitis Optica - Prognosis
What's the prognosis for your neuromyelitis optica?Post View 1 Comment
Neuromyelitis Optica - Diagnosis
How was your neuromyelitis optica diagnosed?Post View 3 Comments
Top Devic's Syndrome Related Articles
azathioprineAzathioprine (Imuran, Azasan) is a drug prescribed for prevention of organ rejection in kidney transplants. Off label uses for azathioprine (Imuran, Azasan) include rheumatoid arthritis, multiple sclerosis, Crohn's disease, myasthenia gravis, ulcerative colitis, and autoimmune hepatitis. Side effects, drug interactions, and safety during pregnancy information should be reviewed prior to taking this drug.
BlindnessBlindness is the state of being sightless. Causes of blindness include macular degeneration, stroke, cataract, glaucoma, infection and trauma. Symptoms and signs may include eye pain, eye discharge, or the cornea or pupil turning white. Treatment of blindness depends upon the cause of the blindness.
corticosteroids-oralOral and injectable systemic corticosterois are steroid hormones prescribed to decrease inflammation in diseases and conditions such as arthritis (rheumatoid arthritis, for example), ulcerative colitis, Crohn's disease, asthma, bronchitis, some skin rashes, and allergic or inflammatory conditions that involve the nose and eyes. Examples of systemic corticosteroids include hydrocortisone (Cortef), cortisone, prednisone (Prednisone Intensol), prednisolone (Orapred, Prelone), and methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol). Some of the side effects of systemic corticosteroids are swelling of the legs, hypertension, headache, easy bruising, facial hair growth, diabetes, cataracts, and puffiness of the face.
Fecal IncontinenceBowel or fecal incontinence refers to the loss of voluntary control of stool, or bowel movements. The condition can include partial incontinence, in which a person loses only a small amount of liquid waste, to complete incontinence, in which the entire bowel movement cannot be controlled. Diet changes and elimination of certain medications can help patients to regain bowel control. Treatment involves a combination of medication, biofeedback, and exercise.
Hiccups are a sudden, involuntary contraction of the diaphragm muscle. In general hiccups are just a temporary condition. Some of the causes of hiccups include certain medications, surgery, eating or drinking too much, spicy foods, diseases or conditions that irritate the nerves controlling the diaphragm, strokes, brain tumors, liver failure, and noxious fumes. There are a variety of home remedies and treatments that can be used to get rid of hiccups.
methylprednisoloneMethylprednisolone (Medrol, Depo-Medrol, Solu-Medrol) is a medication prescribed to patients to suppress inflammation from a variety of conditions and diseases. Side effects, drug interactions, dosage, and pregnancy safety information should be reviewed prior to taking this medication.
MRI ScanMRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
Muscle SpasmsMuscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
Nausea and Vomiting
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. There are numerous cases of nausea and vomiting. Some causes may not require medical treatment, for example, motion sickness, and other causes may require medical treatment by a doctor, for example, heart attack, lung infections, bronchitis, and pneumonia.
Some causes of nausea and vomiting may be life threatening, for example, heart attack, abdominal obstruction, and cancers.
Treatment of nausea and vomiting depends upon the cause.
Optic NeuritisOptic neuritis is inflammation of the optic nerve, the structure that connects the eye to the brain. The precise cause of optic neuritis is unknown, but it is thought to be a type of autoimmune disorder. Optic neuritis most commonly develops due to an autoimmune disorder that may be triggered by a viral infection.
Urinary IncontinenceThere are many types of urinary incontinence (UI), which is the accidental leakage of urine. These types include stress incontinence, urge incontinence, and overflow incontinence. Urinary incontinence in men may be caused by prostate or nerve problems. Treatment depends upon the type and severity of the UI and the patient's lifestyle.
Urinary Incontinence in ChildrenUrinary incontinence in children (enuresis) is twice as common in boys as in girls and may occur during the daytime or nighttime. Nighttime urinary incontinence is also called bedwetting and sleepwetting. The cause of nighttime incontinence in children is unknown. Daytime incontinence in children may be caused by an overactive bladder. Though many children overcome urinary incontinence naturally, it may be necessary to treat incontinence with medications, bladder training and moisture alarms, which wake the child when he or she begins to urinate.
Urinary Incontinence in WomenMillions of women suffer from urinary incontinence (UI). UI occurs twice as often in women as in men. There are many types of urinary incontinence: stress incontinence, urge incontinence, overactive bladder, functional incontinence, overflow incontinence, transient incontinence, and mixed incontinence.
Visual Field TestA visual field test is used to assess a person's central and peripheral vision and detect signs of glaucoma damage to the optic nerve, eyelid conditions such as ptosis, optic nerve disease, and diseases that affect visual pathways in the brain.