Neuromyelitis optica

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Neuromyelitis optica also known as Devic’s disease or Devic’s syndrome is a heterogenous condition consisting of simultaneous inflammation and demyelination of the optic nerve (optic neuritis) and the spinal cord (myelitis).
Inflammation may also affect the brain; the lesions are different from those observed in the related condition, multiple sclerosis.
Lesions of spinal cord lead varying degrees of weakness or paralysis in the legs or arms, loss of sensation or bladder dysfunction and bowel dysfunction.
Devic’s disease is a rare disorder which resembles multiple sclerosis in several ways, but requires a different course of treatment of optimal results.

Age/sex prevalance of Neuromyelitis optica

Devic’s disease is more common in women than in men.

Races affected by Neuromyelitis optica

Incidence of neuromyelitis optica is more seen in individuals who live in temperate climates and of white races.

Causes of Neuromyelitis optica

Devic’s disease is associated with many systemic diseases Such conditions include
• Collagen vascular disease
• Antibody syndromes
• Infections
• Varicella-zoster virus
• Epstein – Barr virus
• HIV

Neuromyelitis optica Sign and Symptoms

The major symptoms of devic’s disease is
• Loss of vision and spinal cord functions.
• Visual impairment with decreased visual activity
• Visual field defects or loss of color vision may occur in isolation.
• Spinal cord dysfunction can lead to
Muscle weakness
Reduced sensation
Loss of bladder and bowel control
• Acute and severe spastic weakness of legs or all four limbs with sensory signs, often accompanied by loss of bladder control.

Investigations of Neuromyelitis optica

There are two criteria on the basis of which diagnosis is made
Absolute criteria
• Optic neuritis
• Acute myelitis
Supportive criteria
• CSF investigations
• Brain MRI not helpful at the onset of disease.
• Spinal cord MRI will indicate the lessions

Treatment of Neuromyelitis optica

There is no fixed cure for neuromyelitis optica but there are therapies to treat an attack, to reduce symptoms and to prevent relapses.
Corticosteroid drugs help to stop the attack and reduce the symptoms.
Immunosuppressive drug will help to prevent subsequent attacks of neuromyelitis optica.

Complications of Neuromyelitis optica

Complications of neuromyelitis optica are as follow

•Permanent loss of vision

•Breathing difficulties

•Osteoporosis

•Sexual dysfunction

•Depression

•Paralysis in all four limbs

•Depression

Prognosis of Neuromyelitis optica

Most individuals with neuromyelitis optica have an unpredictable, relapsing course of disease with attacks occurring months or years apart. Disability is cumulative, the result of each attack damaging new areas of myelin.
Normally, some measure of improvement appears in a few weeks, but residual signs and disability may persist, sometimes severely.

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