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What Is The Prognosis For Neuromyelitis Optica?

Neuromyelitis optica affects the nerves in the eyes and spinal cord, causing damage to and destruction of the myelin sheath (the substance that surrounds most nerve fibers) and the underlying nerve fibers.1

Neuromyelitis optica is a demyelinating disease. It causes symptoms similar to multiple sclerosis (MS) and was previously considered a variant of the disease. However, optic neuromyelitis usually attacks the eyes and spinal cord, while multiple sclerosis attacks the brain. The risk of disability is higher in neuromyelitis optica than in multiple sclerosis. Therefore, people with symptoms of neuromyelitis optica should seek medical attention immediately.1,2

It is an autoimmune disease where the immune system has a malfunction and attacks the body’s own tissue. In neuromyelitis optica, the target of the autoimmune process is a protein called aquaporin-4, which is located on the surface of supporting cells (astrocytes) in the brain, spinal cord, and optic nerve. It is believed that damage to the astrocytes leads to demyelination and nerve cell damage.3

The disease has symptomatic treatment options apart from the use of steroids and immunosuppressive drugs or conducting plasma exchange.4

What Is The Prognosis For Neuromyelitis Optica?

What Is The Prognosis For Neuromyelitis Optica?

The prognosis of neuromyelitis optica is favorable if early diagnosis is made followed by successful and thorough drug therapy. Compliance to the treatment is vital for its success.

The prerequisite for treatment success is that the active substances of the prescribed medicines are well absorbed and lead to inflammation suppression. Within a few weeks, significant improvement or recovery can be observed in these patients.

In case of delay or noncompliance to treatment, the otherwise favorable prognosis may worsen quickly. The vision worsens continuously and can lead to permanent blindness to the patient concerned.

Due to the emotional burden of the symptoms, the risk of mental illness or depression cannot be ruled out. The prognosis further gets complicated when the disease becomes chronic in nature. It can trigger permanent damage to your optic nerve. As a result, the patient may have to live with an impaired vision for the rest of his/her life.
People, who already have pre-existing conditions and thus have a weakened immune system, also experience a delay in the healing process or persistent health problems. In these cases, a psychotherapeutic treatment approach may help. Often a combination of emotional and physical factors is observed in patients and psychiatric support can show good results.

Patients who experience a relapse of the disease or recurrent course of attacks require regular drug treatment throughout their lives.4,5

Unpredictability Of The Prognosis

Many patients with neuromyelitis optica have an unpredictable course of the disease. There may be recurring disease progression with the appearance of the symptoms taking place months or years of the first attack. The disability can be cumulative with fresh attacks on new myelin cells at different locations.

Some people are severely affected by neuromyelitis optica and may lose vision of both eyes along with paralysis of arms and legs. Some degree of weakness in limbs is common for most of the patients. Muscle weakness can also cause breathing difficulties and the patient may require artificial ventilation. Respiratory complications and failure are the major causes of death in patients with neuromyelitis optica.

Preventing Neuromyelitis Optica

There is no effective preventive measure identified for neuromyelitis optica. Firstly, there is uncertainty about the exact causes of the disease; on the other hand, it is an autoimmune disease. Such diseases are generally difficult to prevent. It is therefore particularly important to quickly consult a specialist doctor once symptoms of the disease appear. Initiate adequate therapy at the earliest to avoid complications.


Neuromyelitis optica is a difficult disease to control with no preventive measures and complete cure. However, the current treatment approach offers good progression and outcomes. Patients can get relief from symptoms of the disease as well as better prognosis. The outcome of the patients also varies from patient to patient. Usually, the optic nerve is damaged first and limbs get affected days or months (sometimes years) later.


  1. Wingerchuk DM, Weinshenker BG. Neuromyelitis optica. Current treatment options in neurology. 2008;10(1):55-66.
  2. Weinshenker BG. Neuromyelitis optica: what it is and what it might be. The Lancet. 2003;361(9361):889-890.
  3. Wingerchuk DM, Hogancamp WF, O’brien PC, Weinshenker BG. The clinical course of neuromyelitis optica (Devic’s syndrome). Neurology. 1999;53(5):1107-1107.
  4. Wingerchuk DM, Lennon VA, Lucchinetti CF, Pittock SJ, Weinshenker BG. The spectrum of neuromyelitis optica. The Lancet Neurology. 2007;6(9):805-815.
  5. Wingerchuk DM, Weinshenker BG. Neuromyelitis optica: clinical predictors of a relapsing course and survival. Neurology. 2003;60(5):848-853.

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Sheetal DeCaria, M.D.
Sheetal DeCaria, M.D.
Written, Edited or Reviewed By: Sheetal DeCaria, M.D. This article does not provide medical advice. See disclaimer
Last Modified On:August 17, 2019

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