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Why is it Important to Distinguish NMO from MS?

Published on April 2, 2010

Brian Weinshenker, MD:

With neuromyelitis optica, the main disability that occurs, occurs as a result of attacks. It’s different than MS. MS, the attacks tend to be mild. Patients are not disabled by the attacks, but the attacks indicate accumulation of lesions that years later result in a gradual deterioration of nerves which causes the majority of the long-term disability in MS. So we’re talking about a lot longer timeframe in MS. But if there’s anything good to be said about neuromyelitis optica, it is that we rarely see that kind of progressive phase. With neuromyelitis optica, it’s those early and severe attacks that produce most of the disability.

Brian Weinshenker, MD:

I think we have certainly plenty of data that would suggest that these are clinically different, respond differently to treatment, pathologically different. That for the way we should be educating physicians, we should be educating them that these are different diseases. And when you suspect this, the most important thing is to be sure that a patient doesn’t have neuromyelitis optica. Because if it’s MS, in general it’s going to run a milder course and you have some latitude to delay the diagnosis until you’re sure. But with neuromyelitis optica, because each attack can be individually so severe and leave such severe sequelae, I think it’s pretty important if there’s a serious index of suspicion to order the appropriate tests and diagnose neuromyelitis optica early.


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