How are neuromyelitis optica and multiple sclerosis linked?

Neuromyelitis optica (NMO) is an uncommon disease of the central nervous system (CNS) that affects the optic nerves and spinal cord. Originally known as Devic’s Disease, NMO is often misdiagnosed as multiple sclerosis, and until recently, NMO was thought to be a severe variant of multiple sclerosis (MS). Research indicates that NMO and MS are distinct diseases.

Like multiple sclerosis (MS), neuromyelitis optica (NMO) leads to loss of myelin and can cause attacks of optic neuritis and myelitis (inflammation of the spinal cord). However, NMO is different from MS in the severity of its attacks and its tendency to solely strike the optic nerves and spinal cord at the beginning of the disease. Symptoms outside of the optic nerves and spinal cord are rare, although certain symptoms, including uncontrollable vomiting and hiccups, are now recognized as relatively specific symptoms of NMO that are due to brainstem involvement.

The discovery of an antibody in the blood of individuals with NMO gives doctors a reliable biomarker to distinguish NMO from MS. The antibody, known as NMO-IgG, seems to be present in about 70 percent of those with NMO and is not found in people with MS or other similar conditions.

Traditionally, spinal cord lesions seen in NMO are longer than those seen in MS, but this is not always the case. NMO doctors stress the importance for people diagnosed with MS to discuss these symptoms with their doctors to help consider NMO in their diagnoses.

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