Focus on Neuromyelitis Optica vs. Multiple Sclerosis

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Multiple sclerosis is the disorder of the central nervous system, which is the brain and the spinal cord. And neuromyelitis optica is also brain and spinal cord. We used to think that NMO was like a variant of multiple sclerosis. That's before the antibody was discovered. The antibody was discovered only in the last few decades, but now we know that it's a different disease entirely because NMO has an antibody.

So normally, antibodies are good. Antibodies fight against bacteria and viruses. But in NMO, the antibodies are attacking you, and that we call auto immune disease. So the immune system is attacking yourself. This attack is on the nerves. So antibodies are good unless they're attacking you. So MS normally comes and goes-- we call that relapse and remit-- versus NMO, which usually comes and then it just keeps getting worse.

So NMO is a way more severe disease than MS, even though superficially they look the same. So with MS, sometimes it might be tingling in the hand or loss of vision in one eye or double vision. With NMO, the tip-offs are, it's usually severe in both eyes at the same time. It affects the spine, but it's transverse, which cuts across the entire spine. So it's important to know whether you have MS or NMO because the treatment is different.

Multiple sclerosis has medicines that modulate your immune system by making it go up and down. In NMO, because it's antibodies, we have to give medicines that suppress the immune system to stop the antibody production. And so we really want to be aggressive on the immunosuppressive therapy in NMO. We should treat it more aggressively and try and make the diagnosis as early as possible.