Neuromyelitis optica affects only the eyes and spinal cord. It causes acute optic neuritis, sometimes bilateral, plus demyelination of the cervical or thoracic spinal cord. Neuromyelitis optica was previously considered to be a variant of multiple sclerosis (MS) but is now recognized as a different disorder.

Symptoms include visual loss, paraparesis or quadriparesis, and incontinence.

Diagnosis

• Brain and spinal cord MRI
• Visual evoked potentials

Diagnosis usually includes brain and spinal cord MRI and visual evoked potentials. Blood tests to measure an IgG antibody specific for neuromyelitis optica (NMO-IgG) may be done to differentiate it from MS.

Treatment

• Corticosteroids and immunomodulatory or immunosuppressive treatments

There is no cure. However, treatment can prevent, slow, or decrease the severity of exacerbations. Methylprednisolone and azathioprine are often used. Plasma exchange may help people who do not respond to corticosteroids. Rituximab, an anti–B-cell antibody, reduces IgG production and has been shown to be disease-stabilizing.

Treatment of symptoms is similar to that for MS (see Demyelinating Disorders: Symptom control). Baclofen or tizanidine may relieve muscle spasms.

Last full review/revision August 2007 by Brian R. Apatoff, MD, PhD