Is NMO Curable?

NMO (neuromyelitis optica) symptoms may include:

• Optic neuritis, which affects the eyes
  • Loss or blurring of vision in one or both eyes
  • Loss of color vision
  • Eye pain
• Transverse myelitis, which affects the spinal cord
  • Weakness
  • Numbness
  • Paralysis
  • Loss of bowel or bladder control
  • Urinary retention or difficulty emptying the bladder
  • Muscle spasticity (increased tone or stiffness in the extremities)
  • Shooting pain or tingling in the neck, back, or abdomen
  • Uncontrollable nausea and vomiting
  • Uncontrollable hiccups
  • Fatigue
  • Confusion, seizures, or coma (in children)

NMO (neuromyelitis optica) is an autoimmune condition that occurs when the body attacks the myelin that covers the nerves. Most cases of NMO are caused by a specific attack on a type of protein called aquaphorins. The aquaporin-4 (AQP4) water channel is located within the optic nerves and spinal cord which is why these parts of the body are affected. 

NMO (neuromyelitis optica) is diagnosed with a patient history and physical examination. There must be evidence of optic neuritis and transverse myelitis in order to diagnose NMO. 

Other findings that support the diagnosis of NMO include:

• Findings on the brain MRI that do not meet diagnostic criteria for multiple sclerosis (MS), and
• Distinctive, elongated lesions in the spinal cord called longitudinally extensive transverse myelitis (LETM)
• Lesions that involve a large part of the optic nerve or a specific part of the optic nerve, called the optic chiasm
• Positive anti-AQP4 antibodies

Tests used to diagnose NMO includes:

• Neurologic exam, to assess:
  • Mobility
  • Muscle strength
  • Coordination
  • Sensation
  • Memory and thinking functions
  • Speech
  • Vision
• Magnetic resonance imaging (MRI) scan of the brain, optic nerves, and spinal cord
• Spinal tap (lumbar puncture) to examine cerebrospinal fluid (CSF)
• Eye and vision studies
• Optical coherence tomography (OCT)
• Blood tests 
  • NMO-IgG
  • MOG-IgG

Treatment for an initial attack of NMO (neuromyelitis optica) includes: 

• Intravenous (IV) high-dose corticosteroids (methylprednisolone)
• Plasma exchange (PLEX) if there is no improvement with corticosteroids 

There is a high likelihood of recurrence (more than 90%) and attacks are usually severe. 

Treatment is needed to suppress the immune system. Three drugs are approved by the US Food and Drug Administration (FDA) to treat anti-AQP4 positive NMO: 

• Eculizumab (Soliris) 
• Inebilizumab (Uplizna) 
• Satralizumab-mwge (Enspryng) 

Other drugs used off-label to prevent NMO attacks include: 

• Rituximab (Rituxan)
• Mycophenolate mofetil (CellCept)
• Azathioprine (Imuran, Azasan)
• Prednisone
• Methotrexate

Other treatments may include:

• Medications for pain, stiffness, muscle spasms
• Medications for bladder and bowel problems
• Physical and occupational therapy
• Social services to address rehabilitation needs