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Because both neuromyelitis optica and multiple sclerosis are neurological diseases that can result in disability, it’s hard to say that one is worse than the other.

Chronic illnesses can be difficult, and degenerative diseases like multiple sclerosis are even harder because there is no cure or reversal of damage. Such diseases as MS are progressive, and while there are treatments to slow the advancement, there is no way to stop it or to repair the damage already done. Unfortunately, this isn’t the only debilitating disease that can affect the nervous system and lead to potential disability.

Neuromyelitis Optica, or NMO, is a condition of the nervous system, as well, and when compared with MS, the two seem extremely similar in a lot of ways. In fact, many people suffering from NMO are misdiagnosed with multiple sclerosis, which is problematic in getting the correct treatment. In a direct comparison, it’s easy to see why the two may be confused, but digging a little deeper shows just how different the two diseases are.

What is neuromyelitis optica?

The name is derived from the areas of the nervous system that are directly affected by the disease. In neuromyelitis optica, sometimes referred to as Devic’s disease, the body has an autoimmune reaction in which it produces antibodies that attack the optic nerve and spinal cord, two of the three major components of the central nervous system, or CNS. In some cases, it could impact the brain as well.

The exact cause of the disease is unknown, though it seems to appear under some specific circumstances, such as following some sort of infection or when associated with another autoimmune disease. Like many neurological diseases, neuromyelitis optica can ease and have flare ups, and while symptoms and flare ups may be reversible, the disease can cause lingering disabilities that may be permanent, such as blindness.

Neuromyelitis optica (NMO) and multiple sclerosis: symptoms and similarities

It’s important to note that multiple sclerosis and neuromyelitis optica are sometimes confused because, in the past, neuromyelitis optica was mistaken as a form of MS. However, the condition is separate, and even though the two have a lot of similarities, including the fact that they both attack the spinal cord, optic nerve, and the brain (the CNS), they are not the same condition. Some other similarities that create this confusion include:

  • Both diseases can cause optic neuritis, which is swelling in and around the optic nerve. This can lead to pain in the eyes, double or blurred vision, and temporary (or later, permanent) blindness.
  • Both conditions can lead to symptoms throughout the body, based on damage to the nerves in the CNS, including muscle weakness, numbness or tingling in the hands and feet, bladder control problems, and more.
  • Similar tests are run for both conditions to gain a true diagnosis, including MRIs, blood tests, spinal taps (lumbar punctures), and evoked potential (EP) tests. Some of the most conclusive evidence in either condition can come from spinal fluid, which will show elevated levels of a specific antibody produced by the immune system to fight perceived threats in the cells of the CNS.
  • As is the case with a number of neurological diseases, both multiple sclerosis and neuromyelitis optica are more common in women than men.
  • For both conditions, corticosteroids may be administered intravenously to reduce inflammation and help restore balance to the body, which relieves symptoms especially during relapses. Immunosuppressants are also commonly prescribed to help reduce the number of attacks on the CNS in order to prolong health and stability, as well as to create a higher quality lifestyle.

Neuromyelitis optica (NMO) and multiple sclerosis: conditions and differences

Some of the differences between neuromyelitis optica and multiple sclerosis are very minute and require specific testing (like a lumbar puncture) to determine the differences between them. For example, a different antibody is formed in the immune system with each disease. In NMO, the antibody is formed against aquaporin-4, whereas MS presents antibodies that are directly in opposition to a different aspect of the myelin coating on the nerves.

There are plenty of other differences, as well.

  • Both diseases can lead to serious and irreversible damage, which causes disability. However, it can take far longer for those consequences to settle in with multiple sclerosis than NMO, considering that symptoms are usually more severe with NMO and, when untreated far more aggressive.
  • A relapse of multiple sclerosis typically lasts anywhere from twenty-four hours to a week before going into remission. With NMO, a relapse could come on and last up to two months.
  • Some forms of MS do not offer remission periods, consistently plaguing patients with symptoms that are progressively worsening over time. In NMO, patients don’t see progression based on worsening symptoms. Symptoms occur with attacks and are not consistent (with periods of remission throughout the disease). Damage is quick to occur and irreversible, but does not necessarily continue to worsen.
  • Most cases of NMO do not show signs of brain lesions early in the course of the disease, though new research indicates that attacks on the brain may occur later on. By contrast, in multiple sclerosis, most patients present initially with brain lesions that continue and worsen throughout the course of the disease.
  • While both diseases may be treated with immunosuppressants, the first course of therapy for multiple sclerosis usually involves beta interferon, which is a specific anti-inflammatory drug that shows great promise, especially early in the course of the disease. In addition, plasma exchange is one course of eventual treatment option for NMO that is not considered for MS.
  • NMO is common in the same demographic as MS – adult females under the age of forty – but is also more prevalent in males over sixty than other age groups.


Because both neuromyelitis optica and multiple sclerosis are neurological diseases that can result in disability, it’s hard to say that one is worse than the other. What is true is that it’s important to determine which disease is causing problems for the patient so that the proper treatment can be prescribed. Once therapy and treatment are underway, a better prognosis will likely be determined, with fewer long term problems and less chance of severe disability. All of this will help create a fuller and more independent lifestyle for the patient.

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