Optic Neuritis Or Devic’s Disease: What Is It?

Optic neuritis is a serious and chronic autoimmune disease that causes demyelination of the optic nerve and spinal cord. It can be confused with multiple sclerosis, so learn more about the differences in this article.

Autoimmune diseases are a group of pathologies in which the cells responsible for defending the body attack their own organs. This is the case with optic neuritis (neuromyelitis optica, NMO), a disease that involves demyelination of certain areas of the central nervous system (CNS).

A substance called myelin covers the entire central nervous system and is involved in the proper transmission of nerve impulses. In cases of optic neuritis, specific antibodies attack proteins in the spinal cord and optic nerve, aquaporin 4, and alter their proper function.

This condition is also known as Devic’s disease and has a recurrent form of presentation. In fact, relapses occur in 70% of cases. The most common symptoms are changes that have to do with inflammation of the optic nerve and spinal cord.

The similarities and differences between optic neuritis and multiple sclerosis

Multiple sclerosis (MS) is an autoimmune disease that also attacks the central nervous system, making it easy to confuse it with NMO. In fact , for many years experts considered optic neuritis to be a type of multiple sclerosis.

The two current pathologies affect the structures that make up the central nervous system, cause demyelination, and both affect the spinal cord. While MS is able to change several multiple brain structures, NMO only affects the optic nerve.

The symptomatology presented by patients is very similar, as both have recurrent presentations and one-off presentations. At the same time, people with multiple sclerosis also experience optic neuritis and myelitis, so visual and sensory problems are frequent.

The main difference between the two is the humoral change in optic neuritis. Studies have shown that most patients with NMO have aquaporin-4 antibodies, which are very rare in people with MS.

Multiple sclerosis has a more general and less localized involvement and can lead to loss of the ability to walk.

Symptoms of optic neuritis

As already mentioned, the clinical presentation of people with NMO will have to do with optic neuritis and transverse myelitis. It can be bilateral or unilateral, in addition to altering the structure of the optic nerve called the chiasma opticum . Among the relevant ophthalmological symptoms are the following:

Reduced visual acuity
Visual loss
Eye pain
Eye fatigue
Oculomotor dysfunction

At the same time, the spinal cord will also be affected by an inflammatory process in at least 3 segments. Therefore, neurological symptoms may occur. In this sense, the main changes include the following:

Inability to move one or more limbs
Changes in sensitivity
Loss of closure control
Muscle spasms
Nausea and vomiting

People with optic neuritis experience relapse between 2 and 3 years after the first episode. Optic neuritis is more common in women over 39 years of age. In addition , studies show that motor impairment in women is usually worse than in men.

Diagnosis of optic neuritis

Making an accurate diagnosis of this disease can be a complex task for specialists who require a variety of tests. In this regard , the physician must separate other neurological pathologies.

Aquaporin-4 antibodies

One of the main findings that controls the diagnosis of optic neuritis is the presence of aquarone-4 antibodies in the blood. These antibodies are found in more than 70% of patients with the disease. Therefore, they are a clear indication.

These molecules are responsible for the destruction of aquaporin-4 in the central nervous system and subsequent demyelination. Although recently found, it has been shown to be useful in early diagnosis.

Imaging

Magnetic resonance imaging (MRI) is the selected imaging scan used in this case. The test uses magnets and radio waves to create a detailed picture of the structures of the central nervous system. Doctors can detect damage to the brain or spinal cord.

Patients with optic neuromyelitis will have an obvious lesion in the spinal cord, usually at the level of the other vertebra. This is repeated in three consecutive spinal cord segments. This study also determines that the only brain structure that is affected is the optic nerve.

Tests with cerebrospinal fluid

Specialists can remove a small amount of cerebrospinal fluid for an examination of the central nervous system. The fluid we are talking about shows an elevated amount of proteins and white blood cells when a person has neuritis. This is higher than in patients with multiple sclerosis.

Presence of diagnostic criteria

Since 1999, a number of criteria have been established that are present in all patients with optic neuritis. These were modified in 2006. A total of three definitive criteria indicate the presence of the disease:

Optic neuromyelitis
Acute myelitis
Absence of clinical disease outside the spinal cord and optic nerves

The certain possibility that it ends in blindness is a serious consequence of the pathology that is difficult to stop and prevent.

Treatment of optic neuritis

The symptomatology of the disease is due to an inflammatory process. Therefore, the use of corticosteroids helps to reduce the effect of the signs. In addition, this type of medication prevents future relapses.

When corticosteroids do not improve symptoms, plasma transfusion may be necessary. This procedure consists of removing blood from the body and then separating the plasma or fluid from the cells and replacing it with a synthetic analogue.

Plasma transfusion is a process that can take several hours and must be performed several times. Finally, the doctor prescribes immunosuppressive medications. These reduce the activity of the immune system, thus reducing damage to the structures of the central nervous system.

Dietary recommendations for people with NMO

All patients diagnosed with NMO should make a change to have a healthier lifestyle. By doing this, the development of the disease is avoided or slowed down. In particular , dietary changes are crucial.

So a nutritionist needs to monitor patients to help them follow an adequate plan according to the pathology they are reducing. Among the recommendations they can follow are the following:

Increase your intake of plants: fruits, vegetables and grains

Reduce foods rich in saturated fats and carbohydrates
Drink 5 to 8 glasses of water or sugar-free liquid per day
Remove alcohol and coffee intake

NMO: A difficult disease to diagnose

We can conclude that optic neuritis is a degenerative autoimmune disease with ocular and neurological symptoms. Although this pathology is easily confused with other diseases related to the central nervous system, diagnostic methods have come a long way.

Unfortunately, there is no specific treatment for this disease. However, corticosteroids and immunosuppressants help the patient to improve. Finally, people with NMO need to make lifestyle changes to prevent progression and relapse.