Neuromyelitis optica is a rare disorder that can affect the eyes, arms, and legs. It is still unclear what causes the disease, but it is known that your body starts attacking your optic nerve and spinal cord. You may have blurred vision or blindness, dysfunction of bowel movement, muscle spasms, paralysis of limbs or muscle weakness. Uncontrollable hiccups and vomiting may also occur.(1)
Individuals with neuromyelitis optica have optic neuritis that causes pain in the eye followed by blindness. They also develop transverse myelitis that causes numbness or weakness in the limbs. Occasionally, it may lead to paralysis of limbs as well as the loss of bladder and bowel function.(2)
Optic neuromyelitis leads to the loss of myelin, which is a fatty substance that surrounds the nerve fibers and allows nerve signals to pass from one cell to the other. The syndrome can also damage nerve fibers and leave areas of tissue breakdown. In the process of optic neuromyelitis disease, for reasons that are not yet clear, immune system cells and antibodies attack and destroy myelin cells in the optic nerves and spinal cord.(1) (2)
How To Diagnose Neuromyelitis Optica?
If symptoms typical of neuromyelitis optica appear, a suitable neuro specialist should be consulted immediately. The doctor will discuss the medical history of the patient and analyze individual complaints, complications, and symptoms. This usually makes a successful clinical diagnosis possible.
Various neurological examinations may be necessary for an accurate diagnosis. For instance, your doctor may observe for possible signs of inflammation in the optic nerves and the spinal cord. Further scans of the brain may be performed, which in some cases show similar symptoms. To confirm the diagnosis, the presence of aquaporin-4 antibodies is evaluated.
In addition, a magnetic resonance tomography of the skull and the spine is required. For example, in the context of differential diagnosis, multiple sclerosis, and retrobulbar neuritis can be ruled out. It should be noted that, especially at the beginning of the disease, an exact differentiation from multiple sclerosis is not always possible. Retrobulbar neuritis is often associated with similar visual disturbances as neuromyelitis optica, but it does not involve the spinal cord.(3)
What Is The Best Medicine For Neuromyelitis Optica?
There are various options for the treatment of neuromyelitis optica. These are used depending on the individual case and are based on the symptoms of the patient as well as the severity of the symptoms. Both monophasic and chronic multiphasic course of the disease is possible. The tissues may suffer from permanent damage in many cases.
There is no complete cure for neuromyelitis optica. There are therapies to treat an attack as it happens, to reduce the symptoms, and to prevent relapses. Physicians generally treat the first Neuromyelitis optica incidence with corticosteroids. To prevent future recurrence of the symptoms, immunosuppressive drugs such as azathioprine are used.
This treatment differs from that of multiple sclerosis, where mainly special immunomodulators are used. If frequent relapses occur, some people may need to continue a low dose of steroids for long periods.
Studies indicate that the antibody rituximab could also show good efficacy in neuromyelitis optica. In addition to cortisone, relapses in neuromyelitis optica can also be treated by means of plasmapheresis. Plasma exchange (plasmapheresis) is a technique that separates antibodies from the bloodstream and offered to people who do not respond to corticosteroid therapy.
Pain, rigidity, muscle spasms, and bladder and bowel problems can be managed with appropriate medications and therapies. People with major disabilities will require the combined efforts of occupational therapists, physiotherapists, and social services to address their complex rehabilitation needs.(4) (5)
A patient suffering from neuromyelitis optica goes through a painful phase of life. It is a form of the autoimmune disorder where antibodies are formed against the myelin cells in the optic nerves and spinal cord. The disease can be diagnosed through examination by a specialist physician followed by an MRI scan and detection of aquaporin-4 antibodies. There is no complete cure, but the application of steroids, immunosuppressive drugs, and symptomatic treatment offer good outcomes and relief to the patients.
- Cree BA, Goodin DS, Hauser SL. Neuromyelitis optica. Paper presented at: Seminars in neurology2002.
- Pittock SJ. Neuromyelitis optica: a new perspective. Paper presented at: Seminars in neurology2008.
- Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF, Weinshenker BG. Revised diagnostic criteria for neuromyelitis optica. Neurology. 2006;66(10):1485-1489.
- Sellner J, Boggild M, Clanet M, et al. EFNS guidelines on diagnosis and management of neuromyelitis optica. European journal of neurology. 2010;17(8):1019-1032.
- Wingerchuk DM. Diagnosis and treatment of neuromyelitis optica. The neurologist. 2007;13(1):2-11.
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