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The Treatment of Neuromyelitis Optica

Kowarik, Markus C. MD; Soltys, John BS; Bennett, Jeffrey L. MD, PhD

Section Editor(s): Biousse, Valérie MD; Galetta, Steven MD

Journal of Neuro-Ophthalmology: March 2014 - Volume 34 - Issue 1 - p 70–82
doi: 10.1097/WNO.0000000000000102
State-of-the-Art Review

Abstract: Neuromyelitis optica (NMO) is an autoimmune disorder of the central nervous system directed against astrocytes. Initially diagnosed in individuals with monophasic or relapsing optic neuritis and transverse myelitis, NMO is now recognized as a demyelinating disorder with pleiotropic presentations due to the identification of a specific autoantibody response against the astrocyte water channel aquaporin-4 in the majority of individuals. As visual impairment and neurologic dysfunction in NMO are commonly severe, aggressive treatment of relapses and prophylactic immunomodulatory therapy are the focus of treatment. Although there are no approved treatments for NMO, medications and therapeutic interventions for acute and chronic treatment have been the subject of retrospective study and case reports. The goal of this review is to familiarize the reader with biologic and clinical data supporting current treatments in NMO and highlight future strategies based on advancements in our understanding of NMO pathogenesis.

Departments of Neurology (MCK, JLB) and Ophthalmology (JS, JLB), University of Colorado Denver, Denver, Colorado; and Neuroscience Program (MCK, JS, JLB), University of Colorado Denver, Denver, Colorado.

Address correspondence to Jeffrey L. Bennett, MD, PhD, Department of Neurology, University of Colorado Denver, 12700 E.19th Avenue, Box B-182, Aurora, CO 80045; E-mail:

M. C. Kowarik, J. Soltys, and J. L. Bennett were supported by a grant from the National Institutes of Health (EY022936). J. L. Bennett receives additional support from the Guthy-Jackson Charitable Foundation.

The authors report no conflicts of interest.

© 2014 by North American Neuro-Ophthalmology Society