Neuromyelitis optica: keys in diagnosis and treatment

Neuromyelitis optica (NMO), also known as Devic’s disease, is an autoimmune disorder of the central nervous system that primarily affects the spinal cord and the optic nerves. It is a rare but serious condition characterized by recurrent episodes of inflammation and damage to myelin, the protective layer that surrounds nerve fibers.

Symptoms of neuromyelitis optica

The symptoms of neuromyelitis optica (NMO) may vary depending on the severity and location of the attacks. Some of the most common symptoms include:

1. Vision loss: Attacks often affect the optic nerves, which can result in vision loss, blurred vision, or changes in color vision.
2. Pain: Many people with neuromyelitis optica experience severe pain, especially in the lower back region. This pain may be sharp and persistent.
3. Muscle weakness: Episodes of neuromyelitis optica can cause weakness in the legs and arms, which may lead to mobility and coordination problems.
4. Muscle spasms: Some people may experience involuntary muscle spasms as a result of nerve involvement.
5. Coordination problems: Neuromyelitis optica can affect motor coordination, making it difficult to walk or perform tasks that require manual dexterity.
6. Bladder and bowel control problems: Spinal cord involvement can lead to difficulties in controlling the bladder and bowels, which may manifest as urinary incontinence or constipation.
7. Fatigue: Patients with neuromyelitis optica often experience fatigue, which can be debilitating and affect quality of life.

It is important to note that these symptoms may vary in intensity and duration, and not all people with neuromyelitis optica will experience all of them. In addition, obtaining an accurate diagnosis and receiving appropriate treatment as early as possible is essential to control symptoms and prevent disease progression. If you suspect that you may have neuromyelitis optica or experience any of these symptoms, it is crucial to seek medical attention for proper evaluation and diagnosis.

Recurrent attacks

Neuromyelitis optica tends to be characterized by recurrent attacks that may last days, weeks, or even months. Between attacks, some patients may experience partial or complete recovery.

Association with the immune system

Neuromyelitis optica is believed to be an autoimmune disease in which the immune system mistakenly attacks healthy cells of the central nervous system, particularly the aquaporin-4 (AQP4) protein found in astrocytes, the supporting cells of the central nervous system.

Diagnosis of neuromyelitis optica

The diagnosis of neuromyelitis optica (NMO) involves the evaluation of clinical symptoms, imaging tests, and specific laboratory tests. Here are some key aspects of the diagnostic process:

1. Medical history and physical examination: The physician will gather detailed information about the symptoms experienced by the patient, the frequency of episodes, and any triggering factors. The physical examination will focus on neurological function, including the evaluation of vision, muscle strength, reflexes, and coordination.
2. Imaging tests: Imaging tests are essential to evaluate the central nervous system and may include magnetic resonance imaging (MRI) of the brain and spinal cord. In patients with neuromyelitis optica, MRI results often show characteristic lesions in the optic nerve region and spinal cord.
3. Cerebrospinal fluid (CSF) analysis: A lumbar puncture may be performed to obtain a sample of cerebrospinal fluid, which surrounds the brain and spinal cord. CSF analysis may reveal signs of inflammation, such as an increased number of cells and the presence of certain proteins.
4. Anti-AQP4 antibody detection: Most people with neuromyelitis optica have antibodies against the aquaporin-4 (AQP4) protein, which is found in the supporting cells of the central nervous system called astrocytes. The presence of these antibodies in the blood serum can be an important diagnostic tool.
5. Exclusion of other diseases: The physician may also perform tests to rule out other conditions that may present with similar symptoms, such as multiple sclerosis (MS) or other neurological disorders.

It is important to note that the diagnosis of neuromyelitis optica can be a complex process, and collaboration among neurologists, ophthalmologists, and other specialists is common in the evaluation and confirmation of the diagnosis. In addition, since symptoms and findings may vary among individuals, the diagnostic process may be adapted to the specific circumstances of each patient. If neuromyelitis optica is suspected, it is crucial to seek medical attention for a thorough evaluation and accurate diagnosis.

Treatment

The treatment of neuromyelitis optica generally involves managing symptoms and preventing new attacks. Corticosteroids are commonly used to reduce inflammation during acute episodes. In addition, immunosuppressants and disease-modifying therapies may be prescribed to prevent future attacks.

Prognosis

Neuromyelitis optica can cause significant disability, especially if not properly treated. However, with early diagnosis and treatment, many people can live active lives with the disease.

Conclusion

Neuromyelitis optica (NMO) is an autoimmune disease of the central nervous system characterized by recurrent episodes of inflammation and damage to the spinal cord and optic nerves. Symptoms may include vision loss, severe back pain, muscle weakness, muscle spasms, coordination problems, and fatigue.

The diagnosis of neuromyelitis optica involves a comprehensive evaluation that includes reviewing the medical history, a physical examination, imaging tests such as magnetic resonance imaging, cerebrospinal fluid analysis, and the detection of anti-AQP4 antibodies. Excluding other diseases with similar symptoms is also an important part of the diagnostic process.

The treatment of neuromyelitis optica focuses on managing symptoms and preventing new attacks. This may include the use of corticosteroids during acute episodes, immunosuppressants, and disease-modifying therapies to prevent future attacks.

The prognosis may vary, and early diagnosis and treatment are essential to control the disease and prevent long-term disability. Collaboration among healthcare professionals, including neurologists and ophthalmologists, is common in the management of neuromyelitis optica. If this disease is suspected, it is recommended to seek medical attention for a thorough evaluation and appropriate treatment.

If you would like more information about NeuroAiD II, please fill out this contact form.