Diagnosis

Diagnosis at Mayo Clinic

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.

Treatment

Treatment at Mayo Clinic

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).

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Neuromyelitis optica care at Mayo Clinic

Sept. 19, 2015
References
  1. Pereira W, et al. Epidemiological, clinical, and immunological characteristics of neuromyelitis optica: A review. Journal of the Neurological Sciences. 2015;355:7.
  2. NINDS neuromyelitis optica information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/neuromyelitis_optica/neuromyelitis_optica.htm. Accessed Sept. 3, 2015.
  3. Wingerchuk DM, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85:177.
  4. Symptoms and diagnosis of NMO. National Multiple Sclerosis Society. http://www.nationalmssociety.org/What-is-MS/Related-Conditions/Neuromyelitis-Optica-(NMO)/Symptoms-and-Diagnosis. Accessed Sept. 3, 2015.
  5. Riggin EA. Enterprise Performance Management system. Mayo Clinic, Rochester, Minn. July 22, 2015.
  6. Network of pediatric MS centers. National Multiple Sclerosis Society. http://www.nationalmssociety.org/What-is-MS/Who-Gets-MS/Pediatric-MS/Care-for-Pediatric-MS-(Centers-of-Excellence). Accessed Sept. 3, 2015.
  7. Glisson CC. Neuromyelitis optica (NMO) and NMO spectrum disorders. http://www.uptodate.com/home. Accessed Sept. 3, 2015.
  8. Matiello M, et al. Neuromyelitis optica. Current Opinion in Neurology. 2007;20:255.
  9. Riggin EA. Enterprise Performance Management system. Mayo Clinic, Rochester, Minn. Sept. 3, 2015.
  10. Wingerchuk DM, et al. The spectrum of neuromyelitis optica. Lancet Neurology. 2007;6:805.