Rehabilitation of neuromyelitis optica: Two CARE-compliant case reports.

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.

Multidisciplinary rehabilitation for adults with neuromyelitis optica spectrum disorders: A pilot study.

OBJECTIVE: To provide detailed data on the effects of multidisciplinary rehabilitation for patients with neuromyelitis optica spectrum disorder with moderate to severe disability. DESIGN: A pilot randomized control study. SUBJECTS/PATIENTS: A total of 39 patients with neuromyelitis optica spectrum disorder were randomized into intervention or control groups. METHODS: The intervention group received multidisciplinary rehabilitation 5 times/week for 4 weeks in a hospital, and the patients were guided to continue community- or home-based rehabilitation for 3 months. The control group did not receive any specific rehabilitation intervention. Disability was assessed using the Extended Disability Status Scale (EDSS) and Functional Systems (FS) scores after 4 weeks of rehabilitation and 3 months of follow-up. RESULTS: The mean EDSS score was 7.5 at admission for both groups. Improvements (p<0.05) in the EDSS score and domains of bowel, bladder and motor functions (pyramidal and walking function) were noted in the multidisciplinary rehabilitation group after 4 weeks. After 3 months, the patients in the usual care group showed improvement in EDSS score and walking ability score; however, no significant changes in other variables were noted. CONCLUSION: These results suggest that multidisciplinary rehabilitation potentially promotes motor functional recovery in patients with neuromyelitis optica spectrum disorders.

If they are OK, we are OK: the experience of partners living with neuromyelitis optica.

AIM: Neuromyelitis optica (NMO) is a rare neuro-inflammatory condition characterized by acute relapses causing severe visual or physical disability. The impact on family members and their experiences have not been studied. The study aims were to explore the lived experience of partners of people with NMO and to investigate potential carer burden in this population. METHOD: A mixed-method design was used; 11 partners of people with NMO completed semi-structured interviews; 54 partners completed Zarit Burden Interview and Hospital Anxiety and Depression Scale. RESULTS: Three qualitative themes influenced partners' quality of life (QoL): role/relationship; it's all about them; and the impact of NMO. Life changed dramatically for participants after the first NMO attack, necessitating responsibility for physical, financial, social, and emotional support. As NMO symptoms improved and stabilized, freedom and QoL for spouses also improved, albeit with on-going worries regarding the impact of potential devastating future relapses. Quantitative findings showed mild/moderate carer burden (46%), mild/moderate anxiety (59%), and mild/moderate depression (24%). No partner indicated severe carer burden, anxiety, or depression. CONCLUSION: Participants regarded themselves as partners rather than carers whom require assessment and support for their emotional and health well-being. Health-care professionals need to acknowledge the important role partners play in the dynamics of the family unit, through greater discussion and inclusion. Implications for Rehabilitation NMO has a strong impact on couples, resulting in both physical caregiving needs and anxiety regarding the unpredictability of potential devastating relapses. Partners do not necessarily experience clinically significant "burden", anxiety or depression, and tools which screen for this may not capture the nature of their experiences. Health-care professionals need to acknowledge, consult, and respect the experience of partners during assessment and implementation of action plans. Partners should be individually assessed based upon the physical and emotional dependency created by NMO to improve their health and well-being.

Effectiveness of multi-disciplinary rehabilitation for patients with Neuromyelitis Optica.

INTRODUCTION: Neuromyelitis optica (NMO), previously considered a subtype of multiple sclerosis (MS), is now known to be a unique disorder associated with autoantibodies against aquaporin-4. The rehabilitation protocols for MS have been applied to NMO, without specific measures of efficacy. PURPOSE: The evaluation of the effectiveness of an MS type inpatient rehabilitation program for patients with NMO. PATIENT AND METHODS: Retrospective chart reviews of 15 inpatients with NMO and 32 inpatients with MS. Clinical severity was assessed by the Expanded Disability Status Scale (EDSS), functional assessments were scored using the Functional Independence Measure (FIM), the Montebello Rehabilitation Factor Score (MRFS), and the Functional Ambulation Category (FAC). There was a higher percentage of women in the NMO group (87% vs 56% P = 0.003). The MS group had significantly more cognitive and communication deficits (P = 0.003 and P = 0.00001). No significant differences were found in admission FIM, EDSS and FAC scores. RESULTS: Both groups benefitted, however at discharge, the NMO group showed greater improvement in FIM scores (NMO admission 79 ± 24, discharge 98 ± 21; MS admission 80 ± 28, discharge 89 ± 28); and lower EDSS score (NMO from 7.2 ± 1.4 to 6.3 ± 1.4; MS from 7.4 ± 1.4 to 7 ± 1.5). CONCLUSIONS: Inpatient multidisciplinary rehabilitation programs available for the patients with MS may be successfully implemented for patients with NMO.

Successful treatment of paroxysmal tonic spasms with topiramate in a patient with neuromyelitis optica.

A 49-year-old woman with neuromyelitis optica (NMO) developed severe quadriplegia and frequent paroxysmal tonic spasms (PTS). Carbamazepine, although initially effective against PTS, caused drug eruption and she was unable to continue. PTS re-emerged after discontinuation of carbamazepine and hindered rehabilitation. Then topiramate was started, and PTS promptly disappeared. The patient became able to resume rehabilitation and her activity of daily life improved significantly. Carbamazepine and topiramate have a common pharmacological action to block voltage-gated sodium channels. The action may have contributed to inhibition of ephaptic transmission in the demyelinating lesions by NMO and eventually improved PTS.

[Home hospice care, working support and rehabilitation for MS/NMO].

There are a huge amount of physical, mental and financial handicaps to patients with multiple sclerosis (MS) or neuromyelitis optica (NMO) and their family members, although treatment strategies have remarkably progressed recently. Among many important issues, to support them, here we make issues of home hospice care, working support and rehabilitation. We should consider social immaturity and ignorance to resolve the issues, and the key point to contribute useful support is consistent cooperation among medical teams and appropriate understanding of MS/NMO by all the people in our society as well as medical staffs.

Fisioterapia del suelo pélvico en un caso de neuromielitis óptica / Pelvic floor physiotherapy in a case of neuromyelitis optica

La fisioterapia del suelo pélvico en las enfermedades desmielinizantes ha sido poco estudiada. El objetivo del presente estudio es describir los resultados obtenidos con la aplicación de un programa de fisioterapia basado en electroestimulación, biofeedback, gimnasia abdominal hipopresiva y conos vaginales con el fin de mejorar la calidad de vida y reducir los síntomas de la incontinencia urinaria y fecal de una paciente con denervación parcial del suelo pélvico. Se presenta a una mujer de 63 años que presentó 3 episodios de mielopatía dorsal y que fue diagnosticada de neuromielitis óptica, debido a la presencia de anticuerpos IgG anti-NMO, trastornos visuales tras el primer brote y ausencia de lesiones cerebrales en la resonancia magnética. Presentaba incontinencia urinaria y fecal de origen neurógeno. La fisioterapia del suelo pélvico mejoró la calidad de vida de esta paciente con enfermedad desmielinizante y también la severidad de la incontinencia urinaria y fecal

Pelvic floor physiotherapy in myelitis disorders has been little studied. The current study has aimed to describe the results obtained through the application of a physiotherapy program based on electrostimulation, biofeedback, abdominal hypopressive technique and vaginal cones to improve quality of life and to reduce urinary and fecal incontinence symptoms in a patient with partial denervation of the pelvic floor. We present the case of a 63-year-old woman who suffered three episodes of dorsal myelopathy. She was diagnosed with neuromyelitis optica due to the presence of anti-NMO IgG antibodies, visual disorders after the first outbreak and absence of brain lesions in magnetic resonance. She presented urinary and fecal incontinence of neurogenic etiology. Pelvic floor physiotherapy improved the quality of life of this patient with a myelitis disorder and also improved the severity of her urinary and fecal incontinence

Current concept of neuromyelitis optica (NMO) and NMO spectrum disorders.

Neuromyelitis optica (NMO) has been described as a disease clinically characterised by severe optic neuritis (ON) and transverse myelitis (TM). Other features of NMO include female preponderance, longitudinally extensive spinal cord lesions (>3 vertebral segments), and absence of oligoclonal IgG bands . In spite of these differences from multiple sclerosis (MS), the relationship between NMO and MS has long been controversial. However, since the discovery of NMO-IgG or aquaporin-4 (AQP4) antibody (AQP4-antibody), an NMO-specific autoantibody to AQP4, the dominant water channel in the central nervous system densely expressed on end-feet of astrocytes, unique clinical features, MRI and other laboratory findings in NMO have been clarified further. AQP4-antibody is now the most important laboratory finding for the diagnosis of NMO. Apart from NMO, some patients with recurrent ON or recurrent longitudinally extensive myelitis alone are also often positive for AQP4-antibody. Moreover, studies of AQP4-antibody-positive patients have revealed that brain lesions are not uncommon in NMO, and some patterns appear to be unique to NMO. Thus, the spectrum of NMO is wider than mere ON and TM. Pathological analyses of autopsied cases strongly suggest that unlike MS, astrocytic damage is the primary pathology in NMO, and experimental studies confirm the pathogenicity of AQP4-antibody. Importantly, therapeutic outcomes of some immunological treatments are different between NMO and MS, making early differential diagnosis of these two disorders crucial. We provide an overview of the epidemiology, clinical and neuroimaging features, immunopathology and therapy of NMO and NMO spectrum disorders.

Rehabilitation of neuromyelitis optica (Devic syndrome): three case reports.

We describe the inpatient clinical rehabilitation course of three patients with neuromyelitis optica (NMO; Devic syndrome). These patients had varying functional deficits. Each patient improved in several functional independence measures (FIM domains) but had minimal to no progress in other domains after acute rehabilitation stays between 1 and 1.5 mos. NMO is a severe central nervous system demyelinating syndrome distinct from MS, characterized by optic neuritis, myelitis, and at least two of three criteria: longitudinally extensive cord lesion, MRI nondiagnostic for multiple sclerosis, or NMO-IgG seropositivity. Persons with NMO may demonstrate improved function with rehabilitation efforts; though gains may be lost to relapse. Future immunomodulatory intervention may augment the benefits of rehabilitation.

Devic's neuromyelitis optica: a prospective study of seven patients treated with prednisone and azathioprine.

Seven newly diagnosed patients with Devic's neuromyelitis optica were treated with long-term prednisone and azathioprine, and were followed every 2 months for at least 18 months. Their Expanded Disability Status Scale score improved significantly (mean at baseline, 9; mean at 18 months, 3; p < 0.005), and no relapses occurred for more than 18 months. Multicenter controlled studies are needed to prove the efficacy of this therapeutic regimen.