Neuromyelitis optica

Neuromyelitis optica (NMO), also known as Devic's disease, is a rare condition that affects the spinal cord and the nerves of the eyes (optic nerves).

It can cause a wide range of symptoms, such as weakness, blindness, nerve pain and muscle spasms. These will vary from person to person – some may only have one attack of symptoms and recover well, whereas others may be more severely affected and have a number of attacks that lead to disability.

NMO can affect anyone at any age, but it's more common in women than men.

Symptoms of NMO

Each person will experience different symptoms, which can range from mild to severe.

In many people with NMO, the spinal cord becomes swollen and irritated (inflamed). This is called transverse myelitis.

The optic nerve from the eye to the brain can also become inflamed – a condition called optic neuritis.

Some people may only experience transverse myelitis or optic neuritis but, if they have a specific antibody associated with NMO (AQP4) in their blood, they will be said to have NMO spectrum disorder (NMOSD).

Symptoms of optic neuritis and transverse myelitis include:

• eye pain
• loss of vision
• colours appearing faded or less vivid
• weakness in the arms and legs
• pain in the arms or legs – described as sharp, burning, shooting or numbing – and increased sensitivity to cold and heat
• tight and painful muscle spasms in the arms and legs
• bladder, bowel and sexual problems

NMO-UK has more information about the symptoms of NMO.

NMO can be one-off or relapsing. Some people may only have one attack of optic neuritis or transverse myelitis, with good recovery and no further relapses for a long time.

But in very severe cases, more attacks can follow. A relapse can take from several hours up to days to develop. These attacks can be unpredictable and it's not understood what triggers them.

NMO-UK has more information about NMO relapses.

When to get medical help

See a GP if you have any of the above symptoms.

Your GP will refer you to a neurologist (specialist in diseases of the nerves) for further testing to confirm the diagnosis and rule out any other conditions with similar symptoms, such as multiple sclerosis.

You will have an MRI scan of your brain and spinal cord, and blood tests. You may also have a lumbar puncture, where a sample of the fluid surrounding your spine is tested.

NMO-UK has more information about how NMO is diagnosed.

Treatments for NMO

There's no cure for NMO, but treatments can help to ease symptoms, prevent future relapses and slow down the progression of the disease.

You may be prescribed:

• steroids to reduce the inflammation
• medication to suppress your immune system and ease your symptoms, such as azathioprine, mycophenolate or methotrexate
• rituximab, a newer type of drug called a biological, to reduce inflammation

Rehabilitation techniques, such as physiotherapy, can also help if you have problems with your mobility.

Therapies and support groups are available. It might be helpful to read Your guide to care and support.

NMO-UK has more information about treatments for NMO.

Causes

NMO is an autoimmune disorder. This means the body's immune system reacts abnormally and attacks the body's healthy tissues, causing the symptoms of NMO.

NMO is usually not inherited, but some people with NMO may have a history of autoimmune disorders in the family and may have another autoimmune condition themselves.

Driving

Optic neuritis may affect your ability to drive. You have a legal obligation to tell the Driver and Vehicle Licensing Agency (DVLA) about any medical condition that could have an effect on your driving.

See GOV.UK for more information about driving with a disability or health condition.

Support

NMO can have a significant impact, but support is available to help you have the best possible quality of life.

It might help to speak to others who have the same condition or to connect with a charity.

You may find the following links useful:

• NMO-UK
• The Brain & Spine Foundation
• The Brain Charity
• Transverse Myelitis Society
• The Walton Centre and John Radcliffe Hospital – national centres carrying out research into NMO in the UK

Information about you

If you have NMO, your clinical team can pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS).

This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time.

Find out more about the register.