Overview of Neuromyelitis Optica Spectrum Disorder

Neuromyelitis optica spectrum disorder (NMO) is an inflammatory demyelinating disease based on autoimmune abnormalities, mainly affecting the optic nerves and spinal cord. It commonly occurs in young and middle-aged women but can also be seen in children and the elderly. The disease often has an acute onset, with rapidly progressing symptoms. Without timely control, it may cause irreversible neurological damage, severely impacting quality of life.

Global Prevalence

Prevalence in Europe and the United States

In Western countries, the incidence of NMOSD is about 1–4 per 100,000 people. Studies in the United States show the disease is more common in African American and Asian populations, with a strikingly higher incidence in women than men, at a ratio of 9:1.

Situation in Southeast Asia

In countries such as China, Japan, Thailand, and Malaysia, incidence has been rising in recent years. With the widespread availability of anti-AQP4 antibody testing, more cases are being clearly diagnosed. The age of onset in Southeast Asian women is often between 30–50 years.

Main Harms

1. Severe vision impairment

Due to recurrent inflammation of the optic nerves, many patients experience rapid loss of vision in one or both eyes, sometimes progressing to blindness within a short period. Even during remission, permanent visual field defects may remain.

2. Spinal cord dysfunction

Acute inflammation of the spinal cord can cause limb weakness, sensory disturbances, and loss of bladder and bowel control. Severe cases may result in paraplegia or quadriplegia, leaving patients completely dependent on others.

3. Recurrent attacks

The disease tends to relapse, often reoccurring after remission. Each relapse may cause more severe functional impairment, adding to both physical and psychological burdens.

4. Psychological and life impact

Long-term disability, repeated hospitalizations, and vision loss can lead to anxiety, depression, and even feelings of self-abandonment, seriously affecting social functioning and family relationships.

Emerging Treatments

Stem Cell Therapy

In recent years, stem cell therapy has shown promising prospects in the treatment of NMOSD. It not only regulates the immune system and reduces inflammatory responses but may also repair damaged nerve tissue and improve neural conduction function.

① Rebuild immune tolerance and reduce anti-AQP4 antibody levels.

② Improve the neuroinflammatory environment and slow disease progression.

③ Promote repair of optic nerve and spinal cord function, improving quality of life.

④ Suitable for patients with poor response to conventional treatment or frequent relapses.

Conventional Treatments

1. Corticosteroid pulse therapy

This method is used during acute episodes to quickly suppress central nervous system inflammation and control symptoms such as vision loss or paralysis. It generally involves intravenous high-dose methylprednisolone for 3–5 days, followed by a gradual tapering to oral medication.

2. Immunosuppressive maintenance therapy

To prevent relapses, doctors prescribe long-term immunosuppressants such as cyclophosphamide, mycophenolate mofetil, or rituximab, helping patients maintain remission. Regular monitoring of liver and kidney function and infection risk is required during treatment.

3. Plasma exchange therapy

For acute severe cases unresponsive to corticosteroids, plasma exchange can be used to remove pathogenic antibodies from the body, thereby rapidly alleviating symptoms. This method is particularly suitable in the early stages of severe vision loss or paralysis.

4. Rehabilitation and functional training

Rehabilitation includes physical therapy, occupational therapy, and psychological intervention, aiming to enhance muscle strength, coordination, and daily living abilities. Early rehabilitation can prevent disuse atrophy and complications, promoting functional recovery.

Conclusion

NMOSD is a complex and serious condition that often results in vision loss and paralysis, severely impacting quality of life. Experts at United Life International Medical Center emphasize the importance of adopting diverse treatment strategies, including stem cell therapy combined with immune modulation and functional rehabilitation, to provide patients with long-term remission and improvement.