Distinguishing MS from NMO

Optic nerve lesions longer in NMO than MS. #MSBlog #MSResearch

“The study below indicates that NMO (neuromyelitis optica) is associated with longer lesions in the optic nerve than the lesions of typical optic neuritis associated with MS. They recommend a cut-off of 17.6 mm as the length of the lesion to distinguish between the two conditions. Please be aware that these kinds of studies are helpful, but are not the only factors we use when distinguishing between NMO and MS-associated ON. Why is it important to distinguish between the two? The main reason is the treatment of NMO and MS are different as well as the prognosis of recovery. As I write this I wonder if any NMOers read this blog.”

Epub: Mealy et al. Longitudinally extensive optic neuritis as an MRI biomarker distinguishes neuromyelitis optica frommultiple sclerosis. J Neurol Sci. 2015 May 17. pii: S0022-510X(15)00295-6. doi: 10.1016/j.jns.2015.05.013.

OBJECTIVE: To differentiate MRI characteristics of optic neuritis associated with neuromyelitis optica (NMO) and relapsing remitting multiple sclerosis (RRMS).

BACKGROUND: Optic neuritis is a common presenting feature of both neuromyelitis optica and multiple sclerosis. Distinguishing between NMO and RRMS is important in guiding treatment, but biomarkers of NMO and MS can be absent early in the disease process. We looked for differences in MRI characteristics of optic neuritis associated with NMO and MS that provide an early clue in the diagnostic workup.

DESIGN/METHODS: We conducted a retrospective analysis of 26 NMO and 26 RRMS patients presenting to the Johns Hopkins Hospital with MRI-confirmed acute optic neuritis. MRIs were assessed to identify the location and longitudinal extent of each contrast enhancing lesion. For the purposes of this study, the optic nerve was divided into intraorbital, canalicular, pre-chiasmal, chiasmal, and optic tract.

RESULTS: There are distinct differences in MRI characteristics between NMO- and RRMS-associated optic neuritis. The majority of NMO lesions were longitudinally extensive measuring at least 17.6mm in length and involving at least three optic nerve segments. At a cutoff of 17.6mm lesion length, the specificity for NMO is 76.9% with a sensitivity of 80.8% and positive likelihood ratio of 3.50. Conversely, MS lesions were more commonly focal in one optic nerve segment localized anteriorly.

CONCLUSIONS: Optic neuritis in NMO has a distinct pattern on MRI as compared with RRMS and can help differentiate these two neuroinflammatory diseases at presentation.

2 thoughts on “Distinguishing MS from NMO”

  1. Forgive me if this is not 100% relevant here, but is there any explanation for an association with less mobility issues in people with MS who exhibit optic neuritis? With PPMS, I have never (touch wood) had any visual issues.

  2. Just researching NMO as I wait for my neurologist to determine if it would be a more fitting diagnosis than MS. The diagnosis of MS is what I've based everything on for the last 20 years, and I know very little about NMO.

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