Neuromyelitis optica is a severe and chronic autoimmune disease that involves demyelination of the optic nerve and spinal cord. It can be confused with multiple sclerosis.
Autoimmune diseases are a group of pathologies in which the cells in charge of the body’s defense attack its own organs. Neuromyelitis optica (NMO) is a condition that falls within this group and is characteristic for the demyelination of certain areas of the central nervous system (CNS).
The entire CNS is covered by a substance called myelin, which is involved in the correct transmission of nerve impulses. Antibodies will attack aquaporins 4, proteins in the spinal cord and optic nerve, altering their correct functioning.
Doctors call the pathology Devic’s disease and has a relapsing presentation with relapses in 70% of cases. The most frequent symptoms are alterations related to inflammation of the optic nerve and the spinal cord.
Similarities and Differences Between NMO and Multiple Sclerosis
Multiple sclerosis (MS) is an autoimmune disease that also attacks the central nervous system, so it can be confused with NMO. In fact, neuromyelitis optica was a type of multiple sclerosis for many years.
The two affect the central nervous system, causing demyelination. MS is capable of altering various brain structures, while NMO only the optic nerve, even though they both affect the spinal cord.
The symptoms are similar. But, people with multiple sclerosis also have optic neuritis and myelitis, so visual and sensory problems are frequent. The humoral alteration in NMO is the main difference between the two.
Symptoms of neuromyelitis optica
As already stated, the clinic presented by people with NMO will be related to optic neuritis and transverse myelitis. It can be bilateral or unilateral, in addition to altering a structure of the optic nerve called the optic chiasm. The following symptoms stand out:
- Decreased visual acuity.
- Sight loss.
- Eye pain.
- Tiredness in the eyes.
- Oculomotor dysfunction.
On the other hand, t an inflammatory process in at least 3 segments will also affect the spinal cord, so neurological symptoms may appear:
- Inability to move one or more limbs.
- Alterations in sensitivity.
- Loss of sphincter control.
- Muscle spasms.
- Nausea and vomiting.
Relapses may happen between 2 and 3 years after the initial episode in people with the diagnosis. Women from the age of 39 most commonly have the disease. Studies show that the motor impairment in women is usually worse than in men.
How to diagnose it?
Making the precise diagnosis of this pathology can be a complex task for specialists, so a series of different tests will be necessary. In this sense, the doctor must make a distinction with other neurological pathologies.
Anti-aquaporin 4 antibodies
Anti-aquaporin 4 antibodies in the bloodstream in the results help the diagnosis of neuromyelitis optica. These antibodies are found in more than 70% of patients with the disease, so they are a clear indication.
Imaging studies
The test for magnetic resonance uses magnets and radio waves to create a detailed picture of CNS structures. Some damage to the brain or spinal cord can be detected by your doctor.
Patients with neuromyelitis optica will have an evident lesion in the spinal cord, generally at the level of the second thoracic vertebra, which will be repeated in 3 consecutive spinal segments. Furthermore, the examination determines that the only brain structure affected is the optic nerve.
Cerebrospinal fluid (CSF) studies
Specialists can remove a small amount of CSF for analysis. The fluid in question shows a high amount of proteins and white blood cells when neuritis occurs, which is higher than those found in patients with multiple sclerosis.
Presence of diagnostic criteria
Since 1999, a series of criteria have been established that are present in all patients with neuromyelitis optica. These were modified in 2006. In total, there are 3 definitive ones that indicate the presence of the disease:
- Optic neuritis.
- Acute myelitis.
- No presence of a clinical disease outside the spinal cord and optic nerves.
Treatment of neuromyelitis optica
The symptomatology of the disease is given by an inflammatory process, so the use of corticosteroids helps to reduce the impact of the signs. In addition, these types of medications prevent future relapses.
When corticosteroids do not improve symptoms, a plasma exchange may be necessary. This procedure involves the removal of blood from the body that is then separated from the plasma or fluid from the cells and replaced with a synthetic analog.
Plasma exchange is a process that can take hours and must be done multiple times. Finally, the doctor prescribes immunosuppressive drugs. These decrease the activity of the immune system, thus reducing damage to the structures of the CNS.
Recommendations for the diet of a person with NMO
All patients diagnosed with NMO must make a change towards a healthier lifestyle, in a way that prevents or slows the progression of the disease. In this sense, it is advisable to make modifications to the diet.
It is important that patients get in control with a nutritionist in order to follow an adequate plan according to the pathology they present. Among the recommendations, the following stand out:
- Increase the intake of vegetables: fruits, cereals and grains.
- Reduce foods rich in saturated fat and carbohydrates.
- Drink between 5 and 8 glasses of water or fluids without sugar.
- Eliminate the consumption of alcohol and coffee.
NMO: a disease difficult to diagnose
Neuromyelitis optica is a degenerative autoimmune disease that presents with ocular and neurological symptoms. Fortunately, diagnostic methods have advanced greatly.
There is no specific treatment for this disease, however, corticosteroids and immunosuppressants help the patient to improve. It is important that people with NMO make changes in their lifestyle in order to avoid progression and the occurrence of relapses.
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