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Neuromyelitis Optica

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Overview

Neuromyelitis optica causes attacks of optic neuritis and transverse myelitis, as can multiple sclerosis (MS).

  • In MS, optic neuritis typically causes visual impairment in one eye at a time, while both eyes may be affected simultaneously in NMO.
  • Transverse myelitis — which refers to inflammation across both sides of the spinal cord at a single level — causes weakness and loss of sensation in the legs and — depending how high on the spinal cord the inflammation occurs — occasionally in the arms. Transverse myelitis can also affect bowel and bladder function. Transverse myelitis attacks tend to be more severe in NMO than in MS, causing more severe symptoms — although that is not always the case.

A new blood test that measures antibodies to aquaporin-4 detects NMO in about 70 percent of cases. This test may identify that a person has NMO even before he or she experiences all the symptoms that lead to a confident diagnosis.

Learn more about NMO through the National Institute of Neurological Disorders and Stroke (National Institutes of Health), the Transverse Myelitis Association and the Guthy Jackson Foundation website.

Treatment

Disease Modification

There is no cure for neuromyelitis optica (NMO) at this time, but there is a medication, Soliris (eculizumab), approved for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive. Soliris was approved by the US Food and Drug Administration on June 27, 2019. Download the medication guide and prescribing information for more information.

Prior to the approval of Soliris, the following medications were used to supporess the immune system to reduce the likelihood of further attacks:
  • mycophenolate mofetil (CellCept)
  • rituximab (Rituxan)
  • azathioprine (Imuran, Azasan)
First Attack Treatment

The standard of care for an initial attack of NMO includes the following:
  • Intravenous (into the vein) high-dose corticosteroids (methylprednisolone)
  • Plasma Exchange (PLEX) if no improvement occurs with corticosteroids. The goal of PLEX is to lower the level of NMO-IgG in the blood.PLEX involves removing blood from the body through a needle and tubing. Through a series of steps, the plasma (the liquid part of the blood) is separated from blood cells and replaced with an artificial plasma substitute; the plasma substitute and blood cells are combined and returned to the body through an intravenous line. The procedure lasts several hours and may be repeated multiple times over a number of days.
Read more about the benefits and risks of these medications.

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