Neuromyelitis optica (NMO) is an autoimmune disorder that affects as many as 10 in 100,000 people, according to the National Organization for Rare Disorders. NMO is characterized by attacks on the optic nerves (optic neuritis) and spinal cord (transverse myelitis).

Early and appropriate treatment is essential for people living with NMO to prevent or reduce flare-ups, which may cause irreversible loss of vision or loss of mobility.

In the past, researchers thought NMO was a type of multiple sclerosis (MS), but they now know it’s a distinct condition. Because NMO can look like MS, many people experience misdiagnosis and delays in treatment.

NMO attacks can be severe and recur in about 90 percent of cases. Preventing these relapses is one goal of immunosuppressive therapy for NMO.

With recent advances in NMO treatments, new drug therapies are available. Ongoing clinical trials offer a promising glimpse into future NMO therapies and potential new hope for those living with the condition.

Medical treatments for NMO aim to reduce the frequency of attacks or relapse and reduce the severity of tissue damage during attacks. There are two courses of treatment: one specific to relapse and the other as a long-term strategy.

Treatment during a relapse

First-line treatment during an NMO attack is typically a high-dose intravenous corticosteroid medication. Doctors may also recommend plasma exchange along with steroids or following intravenous (IV) steroid treatment.

During plasma exchange, a healthcare provider inserts a thin tube called a catheter into a vein in your arm. In some cases, they may place a catheter in your groin or shoulder.

Your blood then goes out through the catheter and into a machine that separates the plasma from the blood cells. The plasma is then replaced with another solution, which is mixed with the blood cells and put back into your body.

Plasma exchange is meant to remove the antibodies that are causing the attack.

Treatment to reduce the frequency of attacks

Doctors may recommend low-dose corticosteroids for long-term use to prevent relapse. Immunosuppressive medications may also form part of a long-term treatment plan. These drugs include:

  • azathioprine (Imuran, Azasan)
  • mycophenolate mofetil (Cellcept)
  • rituximab (Rituxan)
  • prednisone
  • methotrexate

In a 2020 study, another therapy called eculizumab (Soliris) showed reduced risk of relapse in people with NMO who had previously received rituximab.

Eculizumab is one of a few treatments for people with AQP4 antibody-positive NMO. The others include inebilizumab-cdon (Uplizna) and satralizumab-mwge (Enspryng).

People living with NMO may experience mobility problems. Physiotherapy may help with retaining healthy movement and range of motion.

A physiotherapist can provide information and advice about posture and lifting techniques. They can also lead you through exercises to support your body’s specific needs and provide manual therapy to relieve pain and stiffness.

Physiotherapy cannot reverse tissue damage that occurs from NMO, but it can promote your overall mobility.

Immunosuppressive therapies reduce the immune system’s ability to fight off infections and diseases. It’s important to see your doctor regularly, not only to support your health in light of NMO, but to ensure early screening for cancers and other conditions.

While taking these therapies, you should also take steps to avoid infection by washing your hands regularly and staying away from people you know or suspect may be sick.

Wound healing may slow, so you may want to see a doctor even for minor injuries. Dental health may also decline as a result of these medications, so it’s important to maintain regular dental visits.

Long-term drug therapy aims to help prevent relapses or future attacks. Staying on top of your treatment and checking in regularly with your doctor is one way for you to be proactive in preventing attacks.

Practicing good hygiene to prevent contracting other forms of illness can also help you better manage your overall health while you’re taking immunosuppressive medications.

It’s important to have good communication with your doctor. Since NMO is a relatively rare condition, many people are still learning how to manage it and new therapies are still being developed to improve outcomes. Talk with your doctor about any concerns you have about your treatment plan so they can modify it if necessary.

Researchers and drug companies are constantly working to find new therapies that help control NMO and improve quality of life. Some clinical trials are open for enrollment, which means you may be able to participate if you qualify. You can search for NMO clinical trials through the database.

NMO is a rare autoimmune disorder that can cause irreversible, challenging effects without proper diagnosis, treatment, and management.

Although many people with NMO are misdiagnosed with MS, knowledge about the condition is increasing. New and promising therapies offer ways for people to prevent relapses and improve their quality of life.

New research offers opportunities for clinicians and people with NMO to advance their understanding of the condition and expand treatment options.