Neuromyelitis Optica (NMO) and Myelin Oligodendrocyte Glycoprotein (MOG)- Associated Autoimmune Neurological Disorders and Recent Management

Neuromyelitis optica (NMO) is a devastating demyelinating syndrome characterised by optic neuritis (ON) and myelitis, occurring either simultaneously or in sequential relapses. Classical symptoms of NMO include ON, myelitis or area postrema syndrome. The key diagnostic test is the NMO antibody (anti aquaporin-4 antibody [AQP4]) with a sensitivity of 70%-80% and specificity close to 100%. There may be overlap syndromes with Sjögren’s syndrome, systemic lupus erythematosus (SLE), and positive vasculitis antibodies. Cerebrospinal fluid (CSF) analysis shows oligoclonal bands in only 10% of patients, with a mild elevation in white blood cell (WBC) count and protein being commonly observed. There is no cure for NMO, but it is treatable. Some patients recover, but many are left with impaired vision and limb function, which can be severe in some cases. A high dose of intravenous (IV) methylprednisolone pulse is given for 5 days, followed by a prednisolone taper. Depending on treatment response, plasmapheresis or IV immunoglobulin (IVIG) may be used for relapses with incomplete recovery after steroids. Azathioprine, mycophenolate mofetil, rituximab, cyclophosphamide, and mitoxantrone have all been used as preventive treatments.