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What is the Difference Between Monophasic and Relapsing NMO?

Brian Weinshenker:

Well, the two major groups we talk about are monophasic, and this does seem to be a real thing where patients get optic neuritis typically in both eyes within a period of a month, and then may get myelitis and they get one storm of this activity and that’s it. And we follow them beyond three years. And if they have not recurred, we call it monophasic, unlikely to recur. Now we always have to be careful about that because I have seen people with relapses a decade or longer later was said not to occur, but I have seen it happen. So we’re never a hundred percent sure. But when we see this storm of optic neuritis in both eyes and myelitis occurring simultaneously, especially in a younger individual, we think it might be monophasic. And it’s interesting that that group of patients seem to have a more equal sex ratio.

Brian Weinshenker:

That is men and women, boys and girls seem to be more equally affected by that monophasic form. And that may be a different thing. We also find a much lower percentage of patients that have the aquaporin-4 antibodies who have that condition. But by far, the majority are relapsing. They typically get optic neuritis in one eye at a time, and there’s usually an interval of months between then and their myelitis. But it is variable and they usually have the NMO-IgG antibodies. They’re predominantly women, and that is unfortunately the majority of cases because they’re the ones that are going to get the relapses. The long range prognosis is usually worse with that group, not the short term prognosis. The short term prognosis is actually worse with the monophasic group, but they recover as well as they’re going to and don’t get relapses. But the relapsing ones are the ones that we really worry about the most.

 

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