Expert Team Aims to Better Diagnose NMO

Dr. Nancy Sicotte, right, head of the Multiple Sclerosis Center, and Dr. Michael Weisman, head of rheumatology, are working together to find better ways of diagnosing neuromyelitis optica, a rare variant of multiple sclerosis.

Cedars-Sinai neurologists and rheumatologists are teaming up to better detect a rare variant of multiple sclerosis called neuromyelitis optica (NMO).

The two departments have been working together because multiple sclerosis shares similar symptoms with lupus, which is usually treated by rheumatologists. Like multiple sclerosis, where a person's immune system mistakenly damages healthy nerves in the brain and spinal cord, lupus turns the body's own defenses against it.

Michael H. Weisman, MD, chairman and director of the Division of Rheumatology at Cedars-Sinai, said because of symptom similarity, many NMO patients see rheumatologists before they are referred to a neurologist. NMO is very difficult to detect, but awareness goes a long way toward a more accurate diagnosis more of the time.

"Awareness and diagnostic testing are the key to knowing how to treat NMO patients," said Weisman. "NMO is a manageable and a treatable condition. One of the areas neurologist and multiple sclerosis specialist Nancy L. Sicotte, MD, is looking at is the use of new and exciting biologic treatments for NMO, and a lot of those treatments are those we use for lupus."

The one way to tell the difference between the diseases is through imaging of the brain and spinal cord.

NMO patients have spinal cord lesions in three or more segments of the vertebrae, while patients who have multiple sclerosis will have patchy lesions, said Cedars-Sinai neurology resident Mani Nezhad, MD.

And patients with NMO do not have the same classic brain lesions as seen in patients with multiple sclerosis, though lesions may be present in specific areas of the brain and can be mistaken for tumors. This is why recognizing the clinical symptoms are important.

"In the past two years, we've diagnosed 10 people with NMO. These are patients who could have gone unrecognized or could have ended up having unnecessary and invasive brain biopsies," said Sicotte, who is the director of both the Multiple Sclerosis Center and Neurology Residency Training Program at Cedars-Sinai.

What multiple sclerosis and NMO do have in common is how they damage the optic nerve. At the same time, NMO is rare enough that it can be overlooked, Nezhad said.

Weisman said the hope is that the two departments continue to collaborate, and eventually start joint clinical trials.

"We have large number of lupus patients at Cedars-Sinai and Sicotte takes care of multiple sclerosis patients, so it makes sense that we do things together," said Weisman. "Plus, Cedars is a very collaborative institution and we like to see that happen."