Neuromyelitis Optica – Diagnosis and Treatment
Diagnosis
Doctors take careful steps to diagnose neuromyelitis optica (NMO) and rule out similar diseases. Health professionals use a mix of tools, tests, and patient information to confirm the diagnosis.
A doctor first reviews symptoms and past health history. Common symptoms that may raise suspicion for NMO include vision loss, pain in the eyes, repeated episodes of optic neuritis, muscle weakness, sudden numbness, episodes of paralysis, sudden changes in bladder control, and episodes of nausea.
These patterns of symptoms, especially when they repeat or get worse (relapses), can suggest inflammation in the optic nerve or spinal cord.
A typical evaluation includes a neurological exam. Here, a specialist checks for problems with movement, muscle power, balance, feeling, vision, memory, and thinking.
An eye exam may also be part of this check, especially if there are signs of optic nerve swelling or damage.
Several tests help confirm the diagnosis:
MRI Scan: This tool uses magnets and radio waves to take detailed pictures of the brain, optic nerves, and spinal cord. Doctors look for signs of inflammation, swelling, or areas of damage called lesions. These are more likely to appear in certain places in NMO.
Blood Test: One key test checks for the aquaporin-4 immunoglobulin G (AQP4-IgG) antibody. A positive result helps to set NMO apart from diseases like multiple sclerosis (MS). Blood work might also look for other markers, such as serum glial fibrillary acidic protein (GFAP) or myelin oligodendrocyte glycoprotein (MOG-IgG) if needed.
Spinal Fluid Examination: Doctors use a lumbar puncture (spinal tap) to draw a sample of the liquid around the spinal cord. They check for immune cells, proteins, and antibodies that signal inflammation. An unusually high number of white blood cells during an NMO attack warns of the condition.
Evoked Response Test: Technicians place electrodes on the scalp and sometimes other body parts to measure how the brain reacts to light, sound, or touch. This test shows if any nerves or parts of the brain or spinal cord do not work properly.
Optical Coherence Tomography (OCT): This scan views the nerve fibers at the back of the eye. It shows if these fibers have thinned out, which can mean inflammation and damage from NMO.
The table below outlines common diagnostic tools and what they detect:
| Test | What It Checks For | Why It’s Useful |
|---|---|---|
| Neurological exam | Muscle, sensation, vision, and movement | Finds nerve or brain issues |
| MRI scan | Lesions in brain, spinal cord, optic nerve | Detects damage or swelling |
| Blood test (AQP4-IgG) | NMO-specific antibodies | Confirms NMO vs. MS |
| Lumbar puncture | Immune cells/proteins in spinal fluid | Detects inflammation |
| Evoked response test | Brain/nerves’ response to stimuli | Spots nerve damage |
| Optical coherence tomography | Retinal nerve layer thickness | Finds optic nerve damage |
Doctors combine each result and symptom, along with special criteria developed by international experts, to make an accurate diagnosis and start the right treatment plan early.
Treatment
People living with neuromyelitis optica often need a thorough treatment plan that targets both sudden attacks and long-term care.
Since there is no cure for this condition, therapy aims to ease symptoms during a relapse and prevent new episodes. Early and consistent medical care helps control the disease and limit damage.
Treating Attacks
When an attack happens, doctors usually start with corticosteroids such as methylprednisolone. They give this medication through a vein, often for about five days, and then slowly reduce it.
The purpose is to lower inflammation and help the body recover from symptoms. If corticosteroids do not work well enough or as a next step, doctors might use plasma exchange (plasmapheresis).
In this process, medical staff remove some blood, filter it to separate the plasma, and then mix the blood with a solution before returning it to the body. This can help clear out substances that may cause harm.
Medications to Prevent Relapse
Long-term treatment aims to prevent new attacks. Doctors may continue steroids in lower doses or use immunosuppressants.
Monoclonal antibodies are another option. These may lower the risk of future relapses. Doctors might also use intravenous immunoglobulins to help decrease how often relapses happen.
Extra Support
Besides medications, some patients may work with a physical therapist or occupational therapist. These specialists can help improve daily function, manage pain, and support more independence during remission.
Ongoing teamwork between the patient and healthcare professionals leads to better results.
