Current research indicates that neuromyelitis optica (NMO) patients have a 91% to 98% five-year survival rate. Life expectancy has improved from the earlier 68% to 75% five-year survival rate, after the discovery of antibodies known as anti-aquaporin-4 (AQP-4) immunoglobulin G (IgG) present in 70% of NMO patients, and the development of treatments targeting these antibodies.
- Life expectancy with NMO also depends on various factors such as the patient’s age, type of NMO, and severity and frequency of relapses.
- Up to 30% of patients, however, have residual visual and neuromuscular disabilities after the initial attack, which can worsen with relapses.
- Monophasic NMO, a type of NMO that doesn’t relapse has a better prognosis.
What is NMO?
Neuromyelitis optica is a rare inflammatory autoimmune disorder that primarily affects the optic nerve and the spinal cord, and sometimes the brain. NMO is also known as Devic’s disease or neuromyelitis optica spectrum disorder (NMOSD).
NMO is a condition in which the immune system specifically attacks myelin, a fatty sheath that insulates nerve fibers (axons) and enables efficient transmission of nerve signals. The autoimmune attack results in inflammation and damage to the nerve fibers, disrupting nerve cell communication.
NMO can occur at any age from infancy to old age and is far more common in women than men. NMO also appears to be more prevalent in people of Asian and African origin than in Caucasians.
NMO may be of two types:
- Monophasic: Monophasic form is a single attack of NMO lasting for a period of a few days or weeks which does not recur. This form is uncommon and affects both sexes equally.
- Relapsing: The relapsing form of NMO is characterized by periodic flare-ups with intervals of remission which can last anything from weeks to even decades. This form is more common than the monophasic form and is up to 7 times more prevalent in women than in men.
What are the symptoms of NMO?
The symptoms of NMO arise either out of optic neuritis and/or transverse myelitis, depending on which nerves are affected.
- Optic neuritis: Optic neuritis is the inflammation of the optic nerve, which can affect one or both eyes. Symptoms include:
- Transverse myelitis: Transverse myelitis is the inflammation of the spinal cord. Symptoms may include any of the following:
What causes NMO?
NMO is the result of an abnormal attack on healthy nerve cells by the immune system. Antibodies (IgG) in the immune system, for unknown reasons, consider certain proteins in the central nervous system a threat and attack them. NMO is caused by two types of antibodies that attack different proteins in the optic nerve and spinal cord:
- Anti-AQP4: In the relapsing type of NMO, anti-AQP4 antibodies (NMO-IgG) form and attack aquaporin-4 protein, damaging the myelin and nerve fibers. Aquaporin is a protein in the cell membrane, which regulates the flow of water molecules in and out of cells. Aquaporin-4 is the most common aquaporin in the optic nerve, spinal cord, and brain.
- Anti-MOG: Anti-myelin oligodendrocyte glycoprotein (MOG) antibodies attack MOG, a component of myelin. Antibodies to MOG are found in monophasic NMO, a less common type of NMO.
It is not clear what exactly triggers the autoimmune attack in NMO and it doesn’t appear to be an inherited condition. Only about 3% of NMO patients report having a relative with the condition, but approximately 50% of patients have a personal or family history of other autoimmune disorders.
What is the best treatment for NMO?
Treatment for NMO is based on several tests that the patient undergoes, which include:
- Physical examination
- Blood tests to detect the presence of NMO antibodies
- Spinal taps to test the cerebrospinal fluid
- Imaging tests such optical coherence tomography (OCT) scans to look for damage in the optic nerve, and CT and MRI scans of the spine
- Tests to rule out closely related autoimmune disorders such as MS
The standard treatment for NMO is threefold:
Management of an acute attack
Acute attacks of NMO are typically treated with the following:
- Intravenous corticosteroids such as methylprednisolone reduce inflammation.
- Plasma exchange (plasmapheresis), a procedure to lower the NMO-IgG in the blood. The patient is connected through an intravenous line to a device that separates the plasma from the blood and replaces it with substitute plasma, which is then reinfused along with the other blood components.
Prevention of future attacks
More than 90% of NMO patients have recurring attacks which are generally severe, so prevention of relapse is an integral part of NMO treatment. Preventive medications are primarily immunosuppressants that lower immune activity in NMO patients.
In 2019 and 2020, the FDA approved three medications to treat anti-APQ4 positive NMO. These medications are lab-engineered human antibodies that specifically target the anti-APQ4 antibodies in NMO, which include:
- Eculizumab (Soliris)
- Inebilizumab (Uplizna)
- Satralizumab-mwge (Enspryng)
Immunosuppressants used off-label to treat NMO include:
Management of symptoms
Treatment for managing symptoms from NMO attacks include various medications to treat vision problems, pain, muscle stiffness, bladder and bowel dysfunction, and rehabilitation therapies.
Is NMO curable?
Currently, there is no cure for NMO, but treatments can reduce the frequency and severity of attacks and alleviate symptoms. The discovery of anti-APQ4 and anti-MOG bodies have improved the prospects for early diagnosis and effective management of the disease.
Is NMO worse than MS?
- Symptoms after an NMO attack are generally more severe than those after multiple sclerosis (MS) attack, though, unlike MS, NMO rarely has a progressive stage between episodes.
- MS episodes are usually mild and patients may or may not accumulate disabilities, but NMO episodes can have debilitating and irreversible effects, and can also lower life expectancy.
- NMO was previously thought to be a variant of MS because many symptoms are common between the two diseases.
- The discovery of anti-AQP4 and anti-MOG antibodies led to the distinction between the two diseases. The two diseases have some distinct features that can be detected with tests.
- Both NMO and MS are autoimmune conditions, but NMO primarily affects the optic nerve and spinal cord while MS can affect any white matter in the central nervous system.
- Anti-AQP4 antibodies are present in 70% of NMO patients, while these antibodies are absent in MS.
- Measles Outbreak in Ohio Declared Over After 85 Cases
- Rare But Dangerous Form of Eating Disorder Could Run in Families
- When Schools Ask Students About Suicide, Those At Risk Get Help Sooner
- Not Just Brushing: 10 Ways to Start Caring for Baby Teeth
- USDA Proposes New Rules to Cut Sugar, Salt in School Meals
- More Health News »
Health Solutions From Our Sponsors
Top What Is the Life Expectancy of Someone With NMO? Related Articles
MS (Multiple Sclerosis) vs. ALS (Amyotrophic Lateral Sclerosis) Differences and SimilaritiesALS (amyotrophic lateral sclerosis, Lou Gehrig's disease) and MS (multiple sclerosis) are both diseases of the nervous system (neurodegenerative). ALS is a disease in which the nerve cells in the body are attacked by the immune system, although it's not considered an autoimmune disease by some scientists. MS is an autoimmune disease in which the insulated covering of the nerves (myelin sheath) in the CNS (central nervous system) degenerate, or deteriorate.
Scientists don't know the exact cause of either problem. However, they have discovered that mutations in the gene that produces the SOD1 enzyme were associated with some cases of familial ALS. Scientists also theorize that multiple sclerosis may be caused by infection or vitamin D deficiency. ALS occurs between 50-70 years of age (the average age of occurrence ALS is 55), and mostly affects men. While MS occurs between 20-60 years of age, and mostly affects women. About 30,000 people in the US have ALS, and an average of 5,000 new diagnoses per year (that's about 15 new cases per week). Worldwide, MS affects more than 2.3 million people, with about 10,000 new cases diagnosed each year (that's about 200 new diagnoses per week).
Some of the signs and symptoms of both diseases include muscle weakness, muscle spasms, problems walking, fatigue, slurred speech, and problems swallowing. ALS signs and symptoms that are different from MS include problems holding the head upright, clumsiness, muscle cramps and twitches, problems holding objects, and uncontrollable periods of laughing or crying. MS signs and symptoms that are different from ALS include vision problems, vertigo and balance problems, sexual problems, memory problems, depression, mood swings, and digestive problems.
There is no cure for either disease, however the prognosis and life expectancy are different. Multiple sclerosis is not a fatal condition, while ALS progresses rapidly and leads to death.
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.
Botox to Treat Multiple Sclerosis (MS)Botulinum toxin is a muscle-relaxing medication used to decrease spasticity related to multiple sclerosis and other neurological conditions. Botulinum toxin is derived from the bacterium Clostridium botulinum. There are three types of botulinum toxin available for therapeutic use.
Is MS Contagious? (Multiple Sclerosis)Multiple sclerosis, or MS, is a degenerative disease of the covering around the nerves in the central nervous system (CNS). Researchers and doctors don't know the exact cause, but many theorize that it may be due to environmental triggers, an autoimmune disease, and viruses (infections).
Symptoms of MS include vision changes, paralysis, vertigo, heat intolerance, slurred speech, sexual dysfunction, and urinary incontinence (the inability to urinate).
There's no vaccine or cure for MS, but the progression and symptoms of the disease can be treated.
Multiple Sclerosis (MS) Symptoms and TreatmentsMultiple sclerosis (MS) symptoms vary from person to person, and can last for days to months without periods of remission. Symptoms of MS include sexual problems and problems with the bowel, bladder, eyes, muscles, speech, swallowing, brain, and nervous system. The early symptoms and signs of multiple sclerosis usually start between age 20 and 40. MS in children, teens, and those over age 40 is rare. Treatment options for multiple sclerosis vary depending on the type and severity of symptoms. Medications may be prescribed to manage MS symptoms.
Multiple Sclerosis (MS)Multiple sclerosis or MS is an autoimmune disorder in which brain and spinal cord nerve cells become demyelinated. This damage results in symptoms that may include numbness, weakness, vertigo, paralysis, and involuntary muscle contractions. Different forms of MS can follow variable courses from relatively benign to life-threatening. MS is treated with disease-modifying therapies. Some MS symptoms can be treated with medications.
Making an MS Friendly HomeAdults with multiple sclerosis may be at risk for injuries, hazards, and falling at home. Some simple home modifications can protect your health and safety and facilitate fall prevention. Reduce your risk of accidents and prevent hazards with these tips.
Multiple Sclerosis (MS) Early Warning Signs and TypesMultiple sclerosis (MS) can be thought of as an immune-mediated inflammatory process involving different areas of the central nervous system (CNS) at various points in time. Early warning signs and symptoms of MS in children, teens, and adults are similar; however, children and teens with pediatric also may have seizures and a complete lack of energy. Adults with MS do not have these signs and symptoms. Other signs and symptoms of MS include inflammation of the optic nerve (optic neuritis), changes in vision, Wiping or having tissues around the eye and moving the eye may be painful, and double vision. There are four types of MS, relapsing remitting MS (RRMS), secondary progressive MS (SPMS), primary progressive MS (PPMS), and progressive relapsing MD (PRMS).
MS QuizMultiple Sclerosis is a debilitating neurological condition. Take the MS Quiz to test your knowledge of the causes, symptoms, risks and treatments.
MS SlideshowMS is an autoimmune disease that attacks the nerves of the central nervous system. Learn about multiple sclerosis (MS) causes, symptoms, and treatment, along with diagnosis and life expectancy.
Famous Faces of MSLearn about celebrities, such as Montel Williams and Jack Osbourne, who are living with multiple sclerosis.
Multiple Sclerosis Symptoms PictureSymptoms of multiple sclerosis may be single or multiple and may range from mild to severe in intensity and short to long in duration. See a picture of Multiple Sclerosis Symptoms and learn more about the health topic.
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.
Multiple Sclerosis: Signs of Multiple Sclerosis RelapseSigns of an MS relapse can vary in type and intensity. This WebMD slideshow lists some of the more common relapse symptoms.
What Does a Person With Face Blindness See?Face blindness is also called prosopagnosia. It is a brain disorder that is characterized by the inability to recognize or differentiate between faces of people. The severity of this condition varies; some may have difficulty differentiating between faces of strangers or newly acquainted people, whereas others may struggle with recognizing even familiar faces. In some severe cases, they may not be able to recognize their own face.
Who Is at High Risk for Multiple Sclerosis?The cause of multiple sclerosis (MS) is not known. But scientists believe that a combination of various factors may put an individual at a higher risk for MS. These factors include immunologic factors, environmental factors, low vitamin D levels, smoking, obesity, Epstein-Barr virus, genetics, and the female gender.