Can You Die From Neuromyelitis Optica?

Neuromyelitis optica is an autoimmune condition that interferes with the optic nerves and spinal cord. It is also referred to as NMO, neuromyelitis optica spectrum disorder (NMOSD), or Devic’s disease. Like all other autoimmune disorders, in the case of neuromyelitis, the immune system attacks healthy cells in the body, in particular, those of the spinal cord and optic nerves. As a result of this condition, patients develop optic neuritis, which leads to loss of vision and pain in the eyes. They can also develop transverse myelitis that causes weakness or paralysis in the limbs – arms and legs – as well as the loss of control of the bladder and bowel. neuromyelitis optica can also affect the brain in that it makes patients experience nausea and vomiting with hiccups due to the part of the brain associated with vomiting being involved.^[1]

The factors that play a great role in survival for patients with neuromyelitis optica are the severity and degree of recovery from disease attacks. The effect and intensity of the attacks on the affected areas i.e. spinal cord, optic nerves and at times the brain also attribute to the survival rate of patients with neuromyelitis optica. The mortality rate of neuromyelitis optica ranges between 9%-32%, which is basically influenced by age, relapse rate, and recovery from attacks. Individuals who are of African descent are also seen to be more prone to death from neuromyelitis optica compared to individuals of other heritage.^[2]

Death is likely for individuals with neuromyelitis optica, and in most cases, it is associated with the disease itself. In other cases, death may come about due to complications associated with the condition. As earlier mentioned, one can either develop optic neuritis or transverse neuritis from the condition itself. In cases where the respiratory center in the medulla is involved, then death can occur, or else one can have a neurogenic acute respiratory failure (ARF). Respiratory dysfunction is one of the side effects of neuromyelitis optica, and about 22% of patients exhibit this after the onset of neuromyelitis optica. In a case where ARF was caused by acute cervical myelitis, there was a 19% occurrence, and in 16 patients, it was an incident of disease relapse, and out of those patients, 15 of them died.^[3]

In a study conducted on clinical predictors of death in neuromyelitis optica spectrum disorder, out of the 17 selected for the study, 4 patients died after a month of admission and 13 died within a 12-month period. As per the results, it was seen that death could arise in cases of lack of preventive therapy, and in patients who are African-American. Generally speaking, for patients with NMO, death can be attributed to respiratory failure, fulminant brain, multi-organ failure, brainstem and/or cervical spine lesions, as well as long-term quadriplegia.^[4]

Complications Of Neuromyelitis Optica

Neuromyelitis optica can lead to a variety of complications depending on the severity and extent of the effect the condition has on the affected areas. Individuals with neuromyelitis optica can develop further complications such as; breathing problems due to muscle weakness, erectile and sexual dysfunction, depression and fragile bones due to long-term use of steroidal medication. Other than that, the obvious complications of neuromyelitis optica are paralysis and vision loss, which can be in both eyes.

Paralysis is cumulative in that it occurs after one has experienced several disease episodes where the spinal cord is involved with each attack damaging a new area in the central nervous system. For patients with relapsing neuromyelitis optica, they can experience some of the complications within 5 years. Respiratory failure in patients with neuromyelitis optica has a 25-50% fatality rate, regardless in most cases, muscle weakness leading to breathing problems is rare, unless the condition has progressed to worse levels.^{[5] [1]}

Conclusion

Neuromyelitis optica is a demyelinating condition since it affects the myelin sheath, which insulates nerves in the body. It is considered a rare condition that affects about 0.052 and 0.44 people in a population of 100,000. In death incidences, some of the factors that have been linked to death are patients with African heritage, respiratory and multiple organ failures, the relapse and recovery rate of disease attacks as well as the severity of the attacks and the effect on areas involved. The estimated mortality rate of neuromyelitis optica is between 9-32%, but the numbers are improving with new discoveries on the condition and better ways of managing it.

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Can You Die From Neuromyelitis Optica?