Rehabilitation of neuromyelitis optica

Abstract

Rationale:Neuromyelitis optica (NMO), also known as Devic syndrome, is a central nervous system demyelinating disease consisting of optic neuritis and myelitis. Several studies have reported the effects of rehabilitation programs and specific exercises on outcomes in individuals with multiple sclerosis, but few have considered individuals with NMO. We present 2 cases of paraplegia due to NMO with rehabilitation outcome.Patient concerns:The first case corresponds to a 65-year-old woman with NMO presented with C4 incomplete American Spinal Injury Association (ASIA) scale D, and the second case is a 41-year-old woman with NMO presented with C1 incomplete ASIA-C.Diagnoses:Two cases were confirmed by positive anti-aquaporin-4 antibody and presence of T2-weighted hyperintense lesion in spinal cord on magnetic resonance imaging.Intervention:The first patient planned for focusing on left hand fine motor training through occupational therapy by strengthening and stretching muscle using E-link (Biometrics Ltd, Newport, UK) during 4 weeks, and the second patient received strengthening lower extremity and gait training using a lower-body positive pressure treadmill (AlterG, Anti-Gravity Treadmill, Fremont, CA) during 4 weeks.Outcomes:After a 4-week rehabilitation, the first patient's manual muscle testing was improved to grade 2/5 to 3+/5 in left upper limb specifically. Also, Spinal Cord Independence Measure (SCIM) was improved 79 to 88. Functional gains were made in bathing, upper-extremity dressing, and using chopsticks independently. Also, the second patient's manual muscle testing improved to grades 1 to 2/5 to 3 to 4/5 generally, and ASIA scale improved C5 incomplete ASIA-D. SCIM was improved to by allowing walking independently and increasing lower-extremity dressing and toileting ability.Lessons:An intensive, multidisciplinary rehabilitation program may lead to neurological and functional gains in patients with NMO.

Neuromyelitis Optica (NMO) in Children: A Rare Case Report

“…But after the adolescence phase, women dominate around 70-90% of all individuals affected by this disease. [1][2][3][4][5][6][7][8][9][10][11]14 In Europe, NMO is very rare in the pediatric population, a cohort study in pediatric patients in Germany shows an age range from 5-14 years. 13 Population-based studies in Europe and Asia reported that incidence and prevalence of NMO ranges from 0.05-0.4 and 0.52-4.4 per 100.000.…”

“…Spinal MRI of patient showed no sign of inflammation in 3 or more segments of the spinal cord (longitudinally extensive transverse myelitis), where as in brain MRI there was also no picture of lesions typical of NMO which are usually located in the hypothalamus, corpus callosum, periventricular or brain stem. [2][3][4] LCS examination was not done due to the patient's condition impossible to do it. LCS examination of NMO usually showed pleocytosis (> 50 cell /mm3) with predominant neutrophil and an increase in protein (100-500 mg/dl).…”

“…The results of a study showed that TPE as early as possible (≤ 5 days) is more beneficial than TPE delays in cases of NMO refractory to intravenous methylprednisolone. [2][3][4][11][12][13][14] IVIG is another important therapy that can affect various immunomodulatory pathways and antigenic-recognition, including humoral and cellular immunity. Several immunosuppressive agents (steroid, azathioprine, rituximab, and mycophenolate mofetil) have also been accepted as long-term therapy for NMO patients.…”

“…NMO is a rare disease, covering 20-30% of diseases related to autoimmune disorders and about 1% of demyelination diseases. [1][2][3][4][5][6][7] NMO is a complex disease caused by interaction between genetic host and environmental factor. The major immunological characteristic of NMO is the antibodyies against aquaporin 4 (AQP4-Ab), which is the main water channel in the brain.…”