Shanan Munoz, M.D. Answers Questions On: Neuromyelitis Optica

NMO and MS are both demyelinating diseases that cause damage to the myelin sheath that surrounds nerve fibers in the brain, optic nerves, and spinal cord. Either one may present with vision loss (due to inflammation of one or both eye nerves) or weakness and numbness of extremities, or difficulties with bowel or bladder control.

Symptoms of NMO can be more severe than symptoms of MS. NMO attacks primarily the optic nerves and the spinal cord. It either minimally involves the brain or doesn’t involve it at all. MS patients tend to have more symptoms like vertigo, facial pain, memory/cognitive problems, and mood problems because they have much more brain involvement, and MS may or may not include optic nerve or spinal cord involvement.

It can be difficult sometimes to determine just by history, exam, and MRIs which disease a patient has. Finding the NMO antibody in blood or spinal fluid can help clinch the diagnosis of NMO.

NMO and MS are both more common in women. There’s a lot of research in this area; it seems to be due to hormonal reasons. For example, people with MS do better when they are pregnant, when their estrogen is higher, and have more relapses in the postpartum period when estrogen drops.

A lot of research is focused on speeding up remyelination, or healing of the myelin – the protective covering of the brain and spinal cord that the immune system attacks with these diseases. We can heal ourselves some – remyelinate – but it’s a slow process. New medicines will hopefully speed that up. Other promising research involves more medications to slow or decrease attacks and disease progression.