Healthline Blogs

Perspectives in MS
Perspectives in MS

Neuromyelitis Optica, Part 2

TEXT SIZE: A A A

In my previous post, I introduced the diagnostic criteria for NMO. There are many similarities between MS and NMO, but there are many important differences. Like MS, patients with NMO suffer from relapses, though the relapses are generally restricted to the optic nerves and spinal cord. When brain lesions in NMO patients do become symptomatic they sometimes produce a unique symptom: intractable hiccups and nausea. One small review of 35 patients with NMO found that 15 patients (43%) had episodes of intractable hiccups and nausea. Though I certainly cannot claim to have seen a large number of MS patients suffer from this symptom, in the few cases I have seen it, I always reconsider whether or not the patient has NMO instead.

Compared with MS, relapses in NMO are generally more severe and patients tend to recover less from the attacks.   Unlike MS, there does not seem to be a progressive phase of the illness. All of the disability comes from these relapses.  Like MS, NMO occurs more commonly in women than in men, and in fact the illness is quite unusual in men. However, unlike MS, NMO is more common in African-Americans and people of Hispanic descent than Caucasians. In MS, the reverse is true.

Relapses in NMO are treated with intravenous steroids, as in MS, but the approved treatments for MS have no clear role in NMO. In fact, there are some studies suggesting they may actually worsen the disease. There are no large clinical trials of treatment options in NMO, but studies of small series of patients support the use of immunosupressive agents. 

Most neurologists are now well aware of NMO. However, I still occasionally see people whom I believe have NMO, who are instead being treated for MS. If patients reading this have any concerns that their illness sounds more like NMO than MS, they should talk to their neurologist and consider having the NMO antibody test. 

Below, I have included MRIs from a patient of mine with NMO. These MRIs illustrate the essential features of NMO and show how it is different from MS.

The MRI below is from a brain of a patient with NMO showing inflammation (circled in red) of both optic nerves as they come together to form a structure termed the optic chiasm. The inflamed area is white, whereas normally it is gray.

Neuromyelitis Optica

 

 

 

 

 

 

 

 

The MRI below shows the long, thick area of inflammation in the cervical spine in a patient with NMO.  In this image, the white area inside the spinal cord shows the inflammation. A normal spinal cord should be a uniform gray color.  Additionally the inflamed area of the spinal cord is thick and swollen. This type of lesion would not be characteristic of MS. 

Neuromyelitis Optica

 

 

 

 

 

 

 

 

 

 

The image below is from a patient with MS, showing multiple small plaques of demyelination. 

Neuromyelitis Optica

  • 1

Tags: Staging & Diagnosis

Was this article helpful? Yes No

Recommended for You

  • A Tincture of Time

    By: Jonathan Howard, MD
    Feb 14, 2012

    One of the most frequent e-mail questions I have received is from someone describing their symptoms and wondering whether or not these symptoms could be due to MS. This, of course, is a common reason for patients to visit an MS Center as well. ...

    Read more »

  • Relying on Tests to Diagnose MS, Part 2

    By: Jonathan Howard, MD
    Feb 06, 2012

    In my previous post, I reviewed the diagnostic criteria for MS and some of the reasons a diagnosis is often not as straightforward any anyone would like. I also explained why doctors put great stock in the MRI and the lumbar puncture results in...

    Read more »

  • Relying on Tests to Diagnose MS, Part 1

    By: Jonathan Howard, MD
    Feb 02, 2012

    Why are doctors so heavily reliant on MRI and lab tests to diagnosis MS? During a recent online chat about MS, one person asked the question: “why are doctors so heavily reliant on MRI and lab tests to diagnosis MS?” This is a good question....

    Read more »

  • Optic Neuritis

    By: Jonathan Howard, MD
    Dec 01, 2011

    One of the most distinctive initial presentations of MS is an entity called optic neuritis. As the name implies, optic neuritis is an inflammatory disorder of the optic nerve. The optic nerve carries visual information from the eye to the brai...

    Read more »

Advertisement

About the Author

Dr. Howard is a neurologist & psychiatrist, and an expert in multiple sclerosis.

Recent Blog Posts

Advertisement
Advertisement