What Are The First Symptoms Of Neuromyelitis Optica & How Do You Test For It?

Neuromyelitis optica is an inflammatory autoimmune disease that affects the central nervous system and leads to a degradation of certain insulating nerve sheaths (the process of demyelination). As a result, inflammation of the optic nerve develops within a period of a few months to two years. This occurs either on one or both sides, affecting one or both eyes. In addition, it may affect the spinal cord (myelitis) or the brain (rare) and cause inflammation. It is believed to be an autoimmune disorder.¹

What Are The First Symptoms Of Neuromyelitis Optica?

Neuromyelitis optica is associated with many typical symptoms and complaints. Characteristic of the disease starts when the myelin sheath of the central nerves gets broken along with a reduction in the outer sheath of optic nerves and nerves of the spinal cord.

In the course of the disease, blurred vision can be observed that may lead in some cases to blindness (Amaurosis).
The blindness is either in one or both eyes and develops within a few hours or days.
In the context of neuromyelitis optica, a cross-sectional syndrome is also possible including sensory disorders, paralysis of the limbs or problems with bladder function/gastrointestinal disorder.

Basically, the disease shows either a monophasic or multiphasic course. It may progress chronically as well. In histological examinations, demyelinating lesions that show similarity to multiple sclerosis is a good indication of the disease, although it is not detectable in every case. There is also a possibility of irreversible necrosis.²

How Do You Test For Neuromyelitis Optica?

If symptoms typical of neuromyelitis optica appear, a suitable specialist should be consulted immediately. Together with the patient concerned, the doctor usually discusses the medical history of the patient and individual complaints/symptoms. This often makes a clinical diagnosis possible.

Your doctor may also suggest various neurological examinations in connection with this disorder. The most common examinations necessary to confirm the disease include checking the inflammation in the optic nerves and the spinal cord. Also, damage to the brain may be evaluated as in some cases your brain may get affected and show similar symptoms. To ensure the diagnosis, the presence of aquaporin-4 antibodies is confirmed.

In addition, typical scans include MRI of the brain and the spinal cord. For example, in the context of differential diagnosis, multiple sclerosis and retrobulbar neuritis have to 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.^3,4

Seek Medical Attention At The Earliest

Vision problems or pain in the area of one or both eyes indicates eye disease. A doctor must determine whether this is a neuromyelitis optica and if necessary initiate further measures. People who are already suffering from a chronic disease of the nerves should quickly contact the responsible doctor if the above-mentioned symptoms occur. Also, people with gastrointestinal diseases or neurological disorders should consult the respective physicians in a timely manner. Consulting a specialist in the early stages of the disease can immensely help in your therapy. Going to your doctor early ensures that the neuromyelitis optica can be detected and treated before further complications. An ophthalmologist is the right person to judge neuromyelitis optica. Concomitant bladder and bowel incontinence should be treated by a gastroenterologist.

If a muscle disease is diagnosed as a complication of the disorder, an orthopedist or a sports physician should also be consulted.⁴

Conclusion

Neuromyelitis optica is a complicated disorder where the body’s own immune system attacks specific cells of your optic nerves and spinal cord. In some cases, the brain tissues are also affected. This may lead to partial or complete blindness to one or both eyes. The blindness can progress fast and may happen within hours or days. It is important to seek doctor’s advice at the earliest after the first onset of the symptoms. Physical examinations, family history, evaluation of the symptoms, and imaging (scans) tests can confirm the disease.

References:

Carroll WM, Fujihara K. Neuromyelitis optica. Current treatment options in neurology. 2010;12(3):244-255.
Pittock SJ, Lennon VA, De Seze J, et al. Neuromyelitis optica and non–organ-specific autoimmunity. Archives of neurology. 2008;65(1):78-83.
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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What Are The First Symptoms Of Neuromyelitis Optica & How Do You Test For It?