Neuromyelitis optica (NMO), previously known as Devic's disease, is a central nervous system disorder that primarily affects the eye nerves (optic neuritis) and the spinal cord (myelitis). Now known in broader terms as neuromyelitis optica spectrum disorder, NMO occurs when your body's immune system reacts against its own cells in the central nervous system, mainly in the optic nerves and spinal cord, but sometimes in the brain.

The cause of neuromyelitis optica is usually unknown, although it may sometimes appear after an infection, or it may be associated with another autoimmune condition. Neuromyelitis optica is often misdiagnosed as multiple sclerosis (MS) or perceived as a type of MS, but NMO is a distinct condition.

Neuromyelitis optica may cause blindness in one or both eyes, weakness or paralysis in the legs or arms, painful spasms, loss of sensation, uncontrollable vomiting and hiccups, and bladder or bowel dysfunction from spinal cord damage. NMO attacks may be reversible, but can be severe enough to cause permanent visual loss and problems with walking.

Children may develop confusion, seizures or coma as a manifestation of NMO.

  • Neuromyelitis optica is complex, and the best care for it is constantly evolving. Each year, Mayo Clinic doctors diagnose and treat more than 3,500 adults and children with neuromyelitis optica (NMO) and other central nervous system disorders including multiple sclerosis, optic neuritis, transverse myelitis and acute disseminated encephalomyelitis.

    Although NMO is relatively uncommon, Mayo Clinic doctors treat more than 150 people with NMO annually, either on-site or through coordination with individuals' doctors at home.

  • We meet all your needs under one roof. Mayo Clinic's multidisciplinary approach ensures that you have a team of specialists collaborating on all aspects of your care.

    Doctors trained in brain and nervous system conditions (neurologists), eye and nervous system conditions (neuro-ophthalmologists), physical medicine and rehabilitation (physiatrists), pain medicine, laboratory medicine, and other areas work together to evaluate and treat people with NMO and related disorders.

  • Pediatric center. The National Multiple Sclerosis Society has recognized the Pediatric Multiple Sclerosis Center at Mayo Clinic in Minnesota as a Pediatric MS Center of Excellence. The multidisciplinary center focuses on the evaluation and treatment of children with multiple sclerosis, NMO and other central nervous system disorders.
  • Our mission to find and share better medical expertise means close contact with people working to discover affected people as early as possible, enhancing understanding of the disease and improving treatment for neuromyelitis optica.

    Neurologists and scientists at Mayo Clinic discovered an autoantibody, NMO-IgG, that is a specific marker of NMO. This antibody may help doctors diagnose neuromyelitis optica and can help identify the disorder from multiple sclerosis.

    Our commitment to expand knowledge for all NMO patients drives current research, as well as our clinical trials of new therapies.

Mayo Clinic in Rochester, Minn., is ranked among the Best Hospitals for neurology and neurosurgery and for rehabilitation, and is ranked high performing for ophthalmology by U.S. News & World Report.

Mayo Clinic doctors perform thorough evaluations to rule out other nervous system (neurological) conditions that have similar signs and symptoms as neuromyelitis optica (NMO). Distinguishing NMO from multiple sclerosis (MS) and other conditions ensures that you receive the most appropriate treatment.

To diagnose your condition, your doctor will review your medical history and symptoms and perform a physical examination. Additional studies may include:

  • Neurological examination. A neurologist will examine your movement, muscle strength, coordination, sensation, memory and thinking (cognitive) functions, and vision and speech. An eye doctor (ophthalmologist) also may be involved in your examination.
  • Magnetic resonance imaging (MRI). An MRI uses powerful magnets and radio waves to create a detailed view of your brain, optic nerves and spinal cord. Your doctor may be able to detect lesions or damaged areas in your brain, optic nerves or spinal cord.
  • Blood serum tests. In blood serum tests, doctors will test for the antibody NMO-IgG, which helps doctors distinguish NMO from MS and other neurological conditions. Mayo Clinic researchers discovered this antibody, which is a specific marker for NMO.

    Your doctor can find this antibody by examining your blood sample, and, in some cases, your spinal fluid. This test helps doctors make an early diagnosis of NMO.

  • Lumbar puncture (spinal tap). During this test, your doctor will insert a needle into your lower back to remove a small amount of spinal fluid. Doctors test the levels of immune cells, proteins and antibodies in the fluid. This test may help your doctor differentiate NMO from MS.

    In NMO, the spinal fluid may show markedly elevated white blood cells during NMO episodes, greater than normally seen in MS, although this doesn't always happen.

  • Evoked potentials. Evoked potentials, also called evoked response tests, test your brain's response to stimuli such as sounds, sights or touch. Doctors attach small wires (electrodes) to your scalp and, in some cases, your earlobes, neck, arm, leg and back. Equipment attached to the electrodes records your brain's responses to stimuli.

    These tests help your doctor to find lesions or damaged areas in the nerves, spinal cord, optic nerve, brain or brainstem.

Doctors trained in brain and nervous system conditions (neurologists) and others have experience treating people with neuromyelitis optica (NMO) and other neurological conditions.

Neuromyelitis optica resembles multiple sclerosis (MS) in several ways, but requires different types of treatment.

Neuromyelitis optica can't be cured, but doctors can help you manage your condition and symptoms. NMO treatment involves therapies to reverse recent symptoms and prevent future attacks.

  • Care to reverse recent symptoms. In the early stage of an NMO attack, your doctor may give you a corticosteroid medication, methylprednisolone (A-methapred, Solu-Medrol), through a vein in your arm (intravenously). You'll usually take the medication for about five days, and then the medication will be tapered off slowly over several days.

    If corticosteroids don't help, your doctor may recommend plasma exchange (plasmapheresis). In this procedure, some blood is removed from your body, and blood cells are mechanically separated from fluid (plasma). Doctors mix your blood cells with a replacement solution and return the blood into your body.

    Doctors can also help manage other symptoms you may experience, such as pain or muscle problems.

  • Preventing future attacks. Doctors may recommend you take a lower dose of corticosteroids for an extensive period of time to prevent future NMO attacks and relapses.

    Your doctor may also recommend taking a medication that suppresses your immune system, in addition to corticosteroids, to prevent future NMO attacks. Immunosuppressive medications that may be prescribed include azathioprine (Imuran, Azasan), mycophenolate mofetil (Cellcept) or rituximab (Rituxan).

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Mayo Clinic doctors trained in neurology, ophthalmology, physical medicine and rehabilitation, laboratory medicine, and other areas diagnose and treat people with neuromyelitis optica at Mayo Clinic's campus in Arizona.

Staff in the Multiple Sclerosis Center at Mayo Clinic in Phoenix/Scottsdale, Arizona, has experience evaluating and treating people with neuromyelitis optica, multiple sclerosis and other conditions.

For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

Mayo Clinic doctors trained in neurology, ophthalmology, physical medicine and rehabilitation, laboratory medicine, and other areas diagnose and treat people with neuromyelitis optica at Mayo Clinic's campus in Florida.

For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

Mayo Clinic doctors trained in neurology, ophthalmology, physical medicine and rehabilitation, pain medicine, laboratory medicine, and other areas diagnose and treat people with neuromyelitis optica at Mayo Clinic's campus in Minnesota.

Neurologists trained in multiple sclerosis have experience evaluating and treating people with neuromyelitis optica, multiple sclerosis and other related conditions at Mayo Clinic in Minnesota.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

At Mayo Clinic in Rochester, Minnesota, doctors trained in pediatric neurology, ophthalmology, physical medicine and rehabilitation, pain medicine, laboratory medicine, and other areas evaluate and treat children with neuromyelitis optica. Children who need hospitalization receive care at the Mayo Eugenio Litta Children's Hospital.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

Mayo Clinic researchers in neurology, neuroimmunology and other areas study causes, genetics, new diagnostic tests and treatments for neuromyelitis optica and related conditions.

Staff in the Center for Multiple Sclerosis and Autoimmune Neurology conducts research in neuromyelitis optica, multiple sclerosis and related conditions.

Mayo Clinic researchers discovered an antibody, NMO-IgG, which is a specific marker for NMO. Testing for this antibody can help diagnose NMO in an early stage and distinguish it from multiple sclerosis (MS) and other conditions.

Mayo Clinic publications

See a list of publications by Mayo Clinic doctors on NMO on PubMed, a service of the National Library of Medicine.

Read an article about multiple sclerosis mimickers.

Sept. 19, 2015