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Neuromyelitis Optica

Neuromyelitis Optica

What is neuromyelitis optica?

Neuromyelitis optica, also called NMO, is a rare yet severe autoimmune inflammatory process affecting the central nervous system. It mainly affects the spinal cord and the optic nerves -- the nerves that carry signals from the eyes to the brain. As a result, the disease can cause paralysis and blindness.

Neuromyelitis optica most often strikes during childhood or when adults are in their 40s. It’s especially common in young women, but men can develop it, too. Experts used to think that NMO was a type of multiple sclerosis. They now think it may be a different condition. The conditions do have some similar symptoms, but these are usually more severe in NMO. Vision problems with multiple sclerosis usually affect one eye at a time, while NMO may affect both eyes at the same time.

There are two types of NMO:

  • Relapsing form, which has periodic flare-ups, with some recovery in between. This is the more common kind, and women are far more likely to have this form than men.
  • Monophasic form, which involves a single attack that lasts a month or two. Men and women get this type equally.

What causes neuromyelitis optica?

With NMO, your immune system attacks a substance in your body called myelin — the insulation around your nerves. Specifically, the myelin cells in the spinal cord and optic nerves are attacked. Usually, people with NMO have flare-ups of the disease that may strike months or years apart. Between these flare-ups, people may have some recovery.


What are the symptoms of neuromyelitis optica?

These are possible symptoms of NMO:

  • Pain in the eyes
  • Loss of vision
  • Weakness or numbness in the arms and legs
  • Paralysis of the arms and legs
  • Difficulty controlling the bladder or bowels
  • Uncontrollable vomiting and hiccups 

How is neuromyelitis optica diagnosed?

Health care providers may do a variety of tests if they suspect NMO including:

  • MRI scan of your brain and spinal cord
  • Tests to check on how well your optic nerves are working
  • Samples of your blood and spinal fluid to check for signs of the disease


How is neuromyelitis optica treated?

Experts don't consider this condition curable. But health care providers can prescribe medicines or other treatments to reduce the effects of the disease and relieve symptoms. These may include:

  • Corticosteroid drugs to halt the immune system's effect on your nerves
  • Immunosuppressant drugs
  • A process called plasmapheresis, which removes proteins from the blood that may be playing a role in the condition
  • Other treatments to address symptoms such as pain and loss of bowel and bladder control

You may also need help from health care providers to cope with blindness and paralysis.

What are the complications of neuromyelitis optica?

There are several possible complications of NMO including:

  • Visual impairment or blindness
  • Paralysis or weakness of one or more limb
  • Stiffness or muscle spasms
  • Loss of bowel or bladder control
  • Depression
  • Fatigue

Living with neuromyelitis optica

Disability from NMO may become worse over time. Most people with NMO develop weakness in their arms and legs. Others may have more severe symptoms. Many people with NMO need to start using a ventilator, which is a machine that helps them breathe. They may also need to work with an occupational therapist or social worker to address their disabilities. 

If you or a family member is diagnosed with NMO, it is important to build a support system that includes family, friends, professionals, and support groups. Individuals with major disabilities may need the support of doctors who specialize in NMO, occupational therapists, physical therapists, and social services professionals.

When should I call my health care provider?

Call your health care provider if you notice sudden changes or find you require more help than usual, or if you have a change in mood, have symptoms of depression or feelings of suicide.

Key points

  • Neuromyelitis optica is a rare but serious disease that affects the central nervous system.
  • There is no cure but there medications and treatments may inhibit future disease flares.
  • Health care providers, physical and occupational therapists, and social workers can help you deal with your disease.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.

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