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From the Department of Neurology (Drs. Wingerchuk, Hogancamp, and Weinshenker) and Health Sciences Research (Dr. O’Brien), Mayo Clinic and Foundation, Rochester, MN.
Address correspondence and reprint requests to Dr. Brian G. Weinshenker, Dept. of Neurology, West 8A, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
OBJECTIVES: To evaluate the spectrum of neuromyelitis optica (NMO), including characteristics of the index events (optic neuritis [ON]) and myelitis), neuroimaging, CSF, and serologic studies, and to evaluate the long-term course.
METHODS: Review of 71 patients with NMO evaluated at the Mayo Clinic between 1950 and 1997.
RESULTS: NMO was either monophasic or relapsing. Patients with a monophasic course (n = 23) usually presented with rapidly sequential index events (median 5 days) with moderate recovery. Most with a relapsing course (n = 48) had an extended interval between index events (median 166 days) followed within 3 years by clusters of severe relapses isolated to the optic nerves and spinal cord. Most relapsing patients developed severe disability in a stepwise manner, and one-third died because of respiratory failure. Features of NMO distinct from "typical" MS included >50 cells/mm3 in CSF (often polymorphonuclear), normal initial brain MRI, and lesions extending over three or more vertebral segments on spinal cord MRI.
CONCLUSIONS: Clinical, laboratory, and imaging features generally distinguish neuromyelitis optica from MS. Patients with relapsing optic neuritis and myelitis may have neuromyelitis optica rather than MS. Patients with a relapsing course of neuromyelitis optica have a poor prognosis and frequently develop respiratory failure during attacks of cervical myelitis.
Key words: Neuromyelitis optica—Devic’s syndrome—Prognosis—Optic neuritis—Myelitis—MS.
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S. Jarius, D. Franciotta, R. Bergamaschi, H. Wright, E. Littleton, J. Palace, R. Hohlfeld, and A. Vincent NMO-IgG in the diagnosis of neuromyelitis optica Neurology, March 27, 2007; 68(13): 1076 - 1077. [Full Text] [PDF]
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I. Miyazawa, I. Nakashima, A. Petzold, K. Fujihara, S. Sato, and Y. Itoyama High CSF neurofilament heavy chain levels in neuromyelitis optica Neurology, March 13, 2007; 68(11): 865 - 867. [Abstract] [Full Text] [PDF]
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C Papeix, J-S Vidal, J de Seze, C Pierrot-Deseilligny, A Tourbah, B Stankoff, C Lebrun, T Moreau, P Vermersch, B Fontaine, et al. Immunosuppressive therapy is more effective than interferon in neuromyelitis optica Multiple Sclerosis, March 1, 2007; 13(2): 256 - 259. [Abstract] [PDF]
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T Fukazawa and S Kikuchi A three-dimensional approach for understanding the spectrum of idiopathic inflammatory demyelinating disorders: importance of the 'attack-related severity' axis Multiple Sclerosis, March 1, 2007; 13(2): 199 - 207. [Abstract] [PDF]
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J. A Cabrera-Gomez, L Quevedo-Sotolongo, A Gonzalez-Quevedo, S Lima, Y Real-Gonzalez, M Cristofol-Corominas, K Romero-Garcia, C Ugarte-Sanchez, J Jordan-Gonzalez, J E G. de la Nuez, et al. Brain magnetic resonance imaging findings in relapsing neuromyelitis optica Multiple Sclerosis, March 1, 2007; 13(2): 186 - 192. [Abstract] [PDF]
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D. M. Wingerchuk, S. J. Pittock, C. F. Lucchinetti, V. A. Lennon, and B. G. Weinshenker A secondary progressive clinical course is uncommon in neuromyelitis optica Neurology, February 20, 2007; 68(8): 603 - 605. [Abstract] [Full Text] [PDF]
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S Watanabe, I Nakashima, T Misu, I Miyazawa, Y Shiga, K Fujihara, and Y Itoyama Therapeutic efficacy of plasma exchange in NMO-IgG-positive patients with neuromyelitis optica Multiple Sclerosis, January 1, 2007; 13(1): 128 - 132. [Abstract] [PDF]
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T. F. Scott, S. L. Kassab, and S. J. Pittock Neuromyelitis optica IgG status in acute partial transverse myelitis. Arch Neurol, October 1, 2006; 63(10): 1398 - 1400. [Abstract] [Full Text] [PDF]
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D Petravic, M Habek, S Supe, and V V Brinar Recurrent optic neuromyelitis with endocrinopathies: a new syndrome or just a coincidence? Multiple Sclerosis, September 1, 2006; 12(5): 670 - 673. [Abstract] [PDF]
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I Nakashima, K Fujihara, I Miyazawa, T Misu, K Narikawa, M Nakamura, S Watanabe, T Takahashi, S Nishiyama, Y Shiga, et al. Clinical and MRI features of Japanese patients with multiple sclerosis positive for NMO-IgG J. Neurol. Neurosurg. Psychiatry, September 1, 2006; 77(9): 1073 - 1075. [Abstract] [Full Text] [PDF]
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G Giovannoni Neuromyelitis optica and anti-aquaporin-4 antibodies: widening the clinical phenotype J. Neurol. Neurosurg. Psychiatry, September 1, 2006; 77(9): 1001 - 1002. [Full Text] [PDF]
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M. Wilejto, M. Shroff, J. R. Buncic, J. Kennedy, C. Goia, and B. Banwell The clinical features, MRI findings, and outcome of optic neuritis in children. Neurology, July 25, 2006; 67(2): 258 - 262. [Abstract] [Full Text] [PDF]
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B. Benedetti, P. Valsasina, E. Judica, V. Martinelli, A. Ghezzi, R. Capra, R. Bergamaschi, G. Comi, and M. Filippi Grading cervical cord damage in neuromyelitis optica and MS by diffusion tensor MRI. Neurology, July 11, 2006; 67(1): 161 - 163. [Abstract] [Full Text] [PDF]
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B. Weinstock-Guttman, M. Ramanathan, N. Lincoff, S. Q. Napoli, J. Sharma, J. Feichter, and R. Bakshi Study of mitoxantrone for the treatment of recurrent neuromyelitis optica (devic disease). Arch Neurol, July 1, 2006; 63(7): 957 - 963. [Abstract] [Full Text] [PDF]
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S. J. Pittock, B. G. Weinshenker, C. F. Lucchinetti, D. M. Wingerchuk, J. R. Corboy, and V. A. Lennon Neuromyelitis optica brain lesions localized at sites of high aquaporin 4 expression. Arch Neurol, July 1, 2006; 63(7): 964 - 968. [Abstract] [Full Text] [PDF]
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 F. Falcini, S. Trapani, L. Ricci, M. Resti, G. Simonini, and M. de Martino Sustained improvement of a girl affected with Devic's disease over 2 years of mycophenolate mofetil treatment Rheumatology, July 1, 2006; 45(7): 913 - 915. [Full Text] [PDF]
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I. Kister, S. Gulati, C. Boz, R. Bergamaschi, G. Piccolo, J. Oger, and M. L. Swerdlow Neuromyelitis optica in patients with myasthenia gravis who underwent thymectomy. Arch Neurol, June 1, 2006; 63(6): 851 - 856. [Abstract] [Full Text] [PDF]
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