The aim of this review paper is to summarize current knowledge on the pathogenesis Selleck INK 128 of AQP4-antibody-related
NMO and to provide an update on the widening clinical spectrum, relevant paraclinical findings and current treatments. First reports on patients with myelitis and amaurosis date back to the early 19th century [18-24]. However, neurologists and ophthalmologists only developed sustained interest in this rare syndrome after Eugène Devic and his student Fernand Gault published a review in 1894 [25,26]. Devic and Gault also coined the term neuro-myélite optique aiguë [25, 26]. In 1907 the Turkish physician Acchioté suggested naming the syndrome after Devic . Epidemiological PCI-32765 and population-based studies suggest that the prevalence of NMO ranges from <1/100 000 to 4·4/100 000 in Europe and North America [27-31]. However, the true number of cases may be higher, as some studies reported a rate of patients misdiagnosed with MS as high as 30–40%, especially before tests for AQP4 antibodies became broadly available [1, 32]. Typical age at onset peaks at approximately 35–45 years, but NMO may also become manifest in children and the elderly [1, 33-39]. Female preponderance is substantially higher in seropositive
(∼9–10:1) than in seronegative patients (∼2:1) [1, 40]. The majority of NMO cases are sporadic, although rare familial cases indistinguishable from the former with respect
to clinical presentation, age and sex distribution have been reported . In more than 90% of patients, NMO is a relapsing disease with attacks of ON, myelitis or both, occurring unpredictably . A monophasic course accounts Etoposide cost for the remaining 10% and is more often associated with simultaneous ON and myelitis [1, 36], while a progressive course seems to be extremely uncommon . Attacks of ON and myelitis are often more disabling and, if untreated, remission is poorer than in MS, which leads to a faster accrual of irreversible neurological disability. Following older studies, approximately 60% of patients exhibited severely impaired ambulation [expanded disability status scale (EDSS)  ≥6] or blindness in at least one eye after a disease course of 7–8 years . Five-year survival rate was reported to be as low as 68% in a North American study on patients seen between 1977 and 1997, which is in strong contrast to more recent studies that report 5-year survival rates of more than 90% [1, 44]. In a small subset of patients the disease may follow a benign course, with only minor disability after up to 10 years [1, 45]. The majority of NMO-related deaths result from severe ascending cervical myelitis or brainstem involvement leading to respiratory failure [1, 36].