Skip to main content

Advertisement

Log in

Common and Rare Manifestations of Neuromyelitis Optica Spectrum Disorder

  • Autoimmunity (TK Tarrant, Section Editor)
  • Published:
Current Allergy and Asthma Reports Aims and scope Submit manuscript

Abstract

The discovery of a highly specific biomarker of neuromyelitis optica (NMO)—the anti-aquaporin-4 (AQP4) antibody—has opened new paths to understanding disease pathogenesis and afforded a way to confirm the diagnosis in clinical practice. An important consequence of the discovery is the broadening of the spectrum of syndromes seen in the context of AQP4 autoimmunity. These syndromes have been subsumed under the rubric of NMO spectrum disorder (NMOSD). The current classification recognizes not only optic neuritis and myelitis as core syndromes of NMOSD but also cerebral, diencephalic, brainstem, and area postrema syndromes. These neurologic syndromes are the focus of our review. AQP4 is also expressed in many organs outside of the central nervous system, and this may explain some of the unusual, non-neurologic features that have been occasionally reported in NMOSD. Our review catalogues non-neurologic manifestations seen in NMOSD and concludes with a discussion of frequently associated autoimmune and neoplastic comorbidities of NMOSD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Wingerchuk DM, Weinshenke BG. Neuromyelitis optica. Clinical predictors of a relapsing course and survival. Neurology. 2003;60(5):848–53.

    Article  PubMed  Google Scholar 

  2. Lucchinetti CF et al. A role for humoral mechanisms in the pathogenesis of Devic’s neuromyelitis optica. Brain. 2002;125:1450–61. A neuropathologic study that presaged the discovery of NMO antibody.

    Article  PubMed  Google Scholar 

  3. Lennon VA, Wingerchuk DM, Kryzer TJ, Pittock SJ, Lucchinetti CF, Fujihara K, et al. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet. 2004;364(9451):2106–12. Now classic paper that announced disocery of NMO Ab.

    Article  CAS  PubMed  Google Scholar 

  4. Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85(2):177–89. Most recent NMOSD classification criteria.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Mealy MA, Whetstone A, Orman G, Izbudak I, Calabresi PA, Levy M. Longitudinally extensive optic neuritis as an MRI biomarker distinguishes neuromyelitis optica from multiple sclerosis. J Neurol Sci. 2015;355(1-2):59–63.

    Article  PubMed  Google Scholar 

  6. Graves J, Kraus V, Soares BP, Hess CP, Waubant E. Longitudinally extensive optic neuritis in pediatric patients. J Child Neurol. 2015;30(1):120–3.

    Article  PubMed  Google Scholar 

  7. Levin MH, Bennett JL, Vekerman AS. Optic neuritis in neuromyelitis optica. Prog Retin Eye Res. 2013;36:159–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Naismith RT, Tutlam NT, Xu J, Klawiter EC, Shepherd J, Trinkaus K, et al. Optical coherence tomography differs in neuromyelitis optica compared with multiple sclerosis. Neurology. 2009;72:1077–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Ratchford JN, Quigg ME, Conger A, Frohman T, Forhman E, Balcer LJ, et al. Optical coherence tomography helps differentiate neuromyelitis optica and MS optic neuropathies. Neurology. 2009;73:302–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Green AJ, Cree BA. Distinctive retinal nerve fiber layer and vascular changes in neuromyelitis optica following optic neuritis. J Neurol Neurosurg Psychiatry. 2009;80:1002–5.

    Article  CAS  PubMed  Google Scholar 

  11. Fernandes DB, Raza AS, Nogueira RG, Wang D, Callegaro D, Hood DC, et al. Evaluation of inner retinal layers in patients with multiple sclerosis or neuromyelitis optica using optical coherence tomography. Ophthalmology. 2013;120(2):387–94. Highlights NMOSD and MS differences on OCT.

    Article  PubMed  Google Scholar 

  12. Apiwattanakul M, Popescu BF, Matiello M, et al. Intractable vomiting as the initial presentation of neuromyelitis optica. Ann Neurol. 2010;68(5):757–61.

    Article  PubMed  Google Scholar 

  13. Wingerchuck DM, Lennon VA, Lucchinetti CF, et al. The spectrum of neuromyelitis optica. Lancet Neurol. 2007;6:805–15.

    Article  Google Scholar 

  14. Liu Y, Wang J, Daams M, Weiler F, et al. Differential patterns of spinal cord and brain atrophy in NMO and MS. Neurology. 2015;84(14):1465–72.

    Article  PubMed  Google Scholar 

  15. Flanagan EP, Weinshenker B, Krecke K, Pittock SJ. Short myelitis lesions in aquaporin-4 IgG positive neuromyelitis optica spectrum disorders. JAMA Neurol. 2014;72:81–7.

    Article  Google Scholar 

  16. Scott TF, Frohman EM, De Seze J, et al. Evidence-based guideline: clinical evaluation and treatment of transverse myelitis: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

  17. Kim W, Park MS, Lee SH, et al. Characteristic brain magnetic resonance imaging abnormalities in central nervous system aquaporin-4 autoimmunity. Mult Scler. 2010;16:1229–36.

    Article  PubMed  Google Scholar 

  18. Pittock SJ, Lennon VA, Krecke K, Wingerchuk DM, Lucchinetti CF, Weinshenker BG. Brain abnormalities in neuromyelitis optica. Arch Neurol. 2006;63:390–6.

    Article  PubMed  Google Scholar 

  19. Cabrera-Gomez JA, Quevedo-Sotolongo L, Gonzalez Quevedo A, et al. Brain magnetic resonance imaging findings in relapsing neuromyelitis optica. Mult Scler. 2007;13:186–92.

    Article  PubMed  Google Scholar 

  20. Nakajima H, Fujiki Y, Ito T, Kitaoka H, Takahashi T. Anti-aquaporin-4 antibody-positive neuromyelitis optica presenting with syndrome of inappropriate antidiuretic hormone secretion as an initial manifestation. Case Rep Neurol. 2011;3:263–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Baba T, Nakashima I, Kanbayashi T, et al. Narcolepsy as an initial manifestation of neuromyelitis optica with anti-aquaporin-4 antibody. J Neurol. 2009;256:287–8.

    Article  PubMed  Google Scholar 

  22. Poppe AY, Lapierre Y, Melancon D, et al. Neuromyelitis optica with hypothalamic involvement. Mult Scler. 2005;11:617–21.

    Article  PubMed  Google Scholar 

  23. Shinoda K, Matsushita T, Furuta K, et al. Wall-eyed bilateral internuclear ophthalmoplegia (WEBINO) syndrome in a patient with neuromyelitis optica spectrum disorder and anti-aquaporin-4 antibody. Mult Scler. 2011;17(7):885–7.

    Article  PubMed  Google Scholar 

  24. Iones A, Howard J. Hypogeusia as a symptom of neuromyelitis optica spectrum disorders. Mult Scler J. 2013;19:1548–9.

    Article  Google Scholar 

  25. Misu T, Fujihara K, Nakashima I, Sato S, Itoyama Y. Intractable hiccup and nausea with periaqueductal lesions in neuromyelitis optica. Neurology. 2005;65(9):1479–82.

    Article  CAS  PubMed  Google Scholar 

  26. Asgari N, Skejoe HP, Lennon VA. Evolution of longitudinally extensive transverse myelitis in an aquaporin-4 IgG-positive patient. Neurology. 2013;81(1):95–6.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Owler B, Pitham T, Dongwei W. Aquaporins: relevance to cerebrospinal fluid physiology and therapeutic potential in hydrocephalus. Cerebrospinal Fluid Res. 2010;7:15.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Clardy SL, Lucchinetti CF, Krecke KN, et al. Hydrocephalus in neuromyelitis optica. Neurology. 2014;82:1841–3.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kim HJ, Paul F, Lana-Peixoto MA, Tenembaum S, Asgari N, Palace J, et al. MRI characteristics of neuromyelitis optica spectrum disorder. An international update. Neurology. 2015;84(11):1165–73. Up-to-date review of radiological features of NMOSD.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Takai Y, Misu T, Nakashima I, et al. Two cases of lumbosacral myeloradiculitis with anti-aquaoporin-4 antibody. Neurology. 2012;79:1826–8.

    Article  PubMed  Google Scholar 

  31. Schmidt F, Göktas O, Jarius S, Wildemann B, Ruprecht K, Paul F, et al. Olfatory dysfunction in patients with neuromyelitis optica. Mult Scler Int. 2013;2013:654501.

    PubMed  PubMed Central  Google Scholar 

  32. Saadoun S, Papadopoulos MC. Role of membrane complement regulators in neuromyelitis optica. Mult Scler. 2015;21(13):1644–54. Possible explanation of why AQP4 – IgG causes damage in the CNS and not in the peripheral tissue.

    Article  CAS  PubMed  Google Scholar 

  33. Deguchi S, Deguchi K, Sato K, et al. HyperCKemia related to the initial and recurrent attacks of neuromyelitis optica. Intern Med. 2012;51:2617–20.

    Article  PubMed  Google Scholar 

  34. Jeret JS, Suzuki N, Takahashi T, Fujihara K. Neuromyelitis optica preceded by hyperCKemia episode. Neurology. 2010;75(2253):2253–4.

    Article  PubMed  Google Scholar 

  35. Guo Y, Lennon VA, Popescu BF, et al. Autoimmune aquaporin 4 myopathy in neuromyelitis optica spectrum. JAMA Neurol. 2014;71:1025–9.

    Article  PubMed  Google Scholar 

  36. Goodyear MJ1, Crewther SG, Junghans BM. A role for aquaporin-4 in fluid regulation in the inner retina. Vis Neurosci. 2009;26(2):159–65.

    Article  PubMed  Google Scholar 

  37. Sotirchos, Saidha S. Optical coherence tomography and retinal segmentation in neurological diseases. Optical Coherence tomography in neurologic diseases. Chapter 13; 156-162

  38. Li J, Verkman AS. Impaired hearing in mice lacking aquaporin-4 water channels. J Biol Chem. 2001;276:31233–7.

    Article  CAS  PubMed  Google Scholar 

  39. Takumi Y, Nagelhus EA, Eidet J, Matsubara A, Usami S, Shinkawa H, et al. Select types of supporting cell in the inner ear express aquaporin-4 water channel protein. Eur J Neurosci. 1998;10:3584–95.

    Article  CAS  PubMed  Google Scholar 

  40. Jarius S, Lauda F, Wildemann B, Tumani H. Steroid-responsive hearing impairment in NMO-IgG/aquaporin-4-antibody-positive neuromyelitis optica. J Neurol. 2013;260:663–4.

    Article  CAS  PubMed  Google Scholar 

  41. De Falco M, Cobellis L, Torella M, et al. Down-regulation of aquaporin 4 in human placenta throughout pregnancy. In Vivo. 2007;21:813–7.

    PubMed  Google Scholar 

  42. Saadoun S, Waters P, Leite MI, et al. Neuromyelitis optica IgG causes placental inflammation and fetal death. J Immunol. 2013;191:2999–3005. Describes link between AQP4 IgG and placenta necrosis in pregnant mice.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Reuss R, Rommer P, Bruck W, Paul F, Bolz M. A woman with acute myelopathy in pregnancy: case outcome. BMJ. 2009;339:1372–3.

    Google Scholar 

  44. Bourre B, Marignier R, Zephir H, et al. Neuromyelitis optica and pregnancy. Neurology. 2012;78:875–9.

    Article  CAS  PubMed  Google Scholar 

  45. Waters PJ, McKeon A, Leite MI, et al. Serologic diagnosis of NMO: a multicenter comparison of aquaporin- 4-IgG assays. Neurology. 2012;78:665–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Nour MM, Nakashima I, Coutinho E, Woodhall M, Sousa F, Revis J, et al. Pregnancy outcomes in aquaporin-4-positive neuromyelitis optica spectrum disorder. Neurology. 2016;86(1):79–87. Risks and outcomes of pregnancies in NMOSD.

    Article  CAS  PubMed  Google Scholar 

  47. Birnbaum J, Kerr D. Devic’s syndrome in a woman with systemic lupus erythematosus: diagnostic and therapeutic implications of testing for the neuromyelitis optica IgG autoanti- body. Arthritis Rheum. 2007;57:347–51.

    Article  PubMed  Google Scholar 

  48. Birnbaum J, Kerr D. Optic neuritis and recurrent myelitis in a woman with systemic lupus erythematosus. Nat Clin Pract Rheumatol. 2008;4:381–6.

    PubMed  Google Scholar 

  49. Jacobi C, Stingele K, Kretz R, et al. Neuromyelitis optica (Devic’s syndrome) as first manifestation of systemic lupus erythematosus. Lupus. 2006;15:107–9.

    Article  CAS  PubMed  Google Scholar 

  50. Iyer A, Elsone L, Appleton R, Jacob A. A review of the current literature and a guide to the early diagnosis of autoimmune disorders associated with neuromyelitis optica. Autoimmunity. 2007;47:154–61.

    Article  Google Scholar 

  51. Pittock SJ, Lennon VA, Seze J, et al. Neuromyelitis optica and non organ-specific autoimmunity. Arch Neurol. 2007;65:78–83.

    Google Scholar 

  52. Zhang B, Zhong Y, Wang Y, et al. Neuromyelitis optica spectrum disorders without and with autoimmune diseases. BMC Neurol. 2014;14:162.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Mehta LR, Samuelsson MK, Kleiner AK, et al. Neuromyelitis optica spectrum disorder in a patient with systemic lupus erythematosus and anti-phospholipid antibody syndrome. Mult Scler. 2008;14:425–7.

    Article  PubMed  Google Scholar 

  54. Komolafe MA, Komolafe EO, Sunmonu TA, et al. New onset neuromyelitis optica in a young Nigerian woman with possible antiphospholipid syndrome: a case report. J Med Case Rep. 2008;2:348.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Koga S, Ikeda K, Nakagomi D, et al. A patient with neuromyelitis optica with positive anti-Ro (SS-A) antibody presenting with intractable hiccup and nausea. Mod Rheumatol. 2011;21:561–2.

    Article  PubMed  Google Scholar 

  56. Kahlenberg JM. Neuromyelitis optica spectrum disorder as an initial presentation of primary Sjögren’s syndrome. YSARH. 2011;40:343–8.

    Google Scholar 

  57. Sofat NN, Venables PJP. Is Sjogren myelopathy Devic disease? Ann Rheum Dis. 2008;67:730–1.

    Article  CAS  PubMed  Google Scholar 

  58. Gökçay F, Celebisoy N, Gökçay A, et al. Primary Sjogren’s syndrome presenting as neuromyelitis optica. Pediatr Neurol. 2007;36:58–60.

    Article  PubMed  Google Scholar 

  59. Hoedemaekers AC, van Breda Vriesman PJ, De Baets MH. Myasthenia gravis as a prototype autoimmune receptor disease. Immunol Res. 1997;16:341–54.

    Article  CAS  PubMed  Google Scholar 

  60. Etemadifar M, Abtahi SH, Dehghani A, et al. Myasthenia gravis during the course of neuromyelitis optica. Case Rep Neurol. 2011;3:268–73.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Vaknin-Dembinsky A, Abramsky O, Petrou P, et al. Myasthenia gravis-associated neuromyelitis optica-like disease: an immunological link between the central nervous system and muscle? Arch Neurol. 2011;68:1557–61.

    Article  PubMed  Google Scholar 

  62. Kister I, Gulati S, Boz C, et al. Neuromyelitis optica in patients with myasthenia gravis who underwent thymectomy. Arch Neurol. 2006;63:851–6.

    Article  PubMed  Google Scholar 

  63. Matijaca M, Pavelin S, Kaliterna DM, et al. Pathogenic role of aquaporin antibodies in the development of neuromyelitis optica in a woman with celiac disease. Isr Med Assoc J. 2011;13:182–4.

    PubMed  Google Scholar 

  64. Meyts I, Jansen K, Renard M, et al. Neuromyelitis optica-IgG (+) optic neuritis associated with celiac disease and dysgam- maglobulinemia: a role for tacrolimus? Eur J Paediatr Neurol. 2011;15:265–7.

    Article  PubMed  Google Scholar 

  65. Salazar R, Cerghet M, Farhat E, Lim HW. Neuromyelitis optica in a patient with pemphigus foliaceus. J Neurol Sci. 2012;319:152–5.

    Article  CAS  PubMed  Google Scholar 

  66. Titulaer MJ, Höftberger R, Iizuka T, et al. Overlapping demyelinating syndromes and anti–N-methyl-D-aspartate receptor encephalitis. Ann Neurol. 2014;75:411–28.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Zamvil SS, Slavin AJ. Does MOG Ig-positive AQP4-seronegative opticospinal inflammatory disease justify a diagnosis of NMO spectrum disorder? Neurol Neuroimmunol Neuroinflamm. 2015;2(1):e62. Discussion of pros and cons of including MOG Ig-positive, anti-AQP4 seronegative patients as part of the NMOSD.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Long Y, Zheng Y, Chen M, et al. Serum thyroid- stimulating hormone and anti-thyroglobulin antibody are independently associated with lesions in spinal cord in central nervous system demyelinating diseases. PLoS One. 2014;9, e100672.

    Article  PubMed  PubMed Central  Google Scholar 

  69. McKeon A, Lennon VA, Jacob A, et al. Coexistence of myasthenia gravis and serological markers of neurological autoimmunity in neuromyelitis optica. Muscle Nerve. 2009;39:87–90. An interesting systematic study of neurologic autoantibodies in NMOSD.

    Article  PubMed  Google Scholar 

  70. Fryer JP, Lennon VA, Pittock SJ, et al. AQP4 autoantibody assay performance in clinical laboratory service. Neurol Neuroimmunol Neuroinflamm. 2014;1, e11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Jarius S, Wildemann B. Aquaporin-4 antibodies (NMO- IgG) as a serological marker of neuromyelitis optica: a critical review of the literature. Brain Pathol. 2013;23:661–83.

    Article  CAS  PubMed  Google Scholar 

  72. Zekeridou A, Lennon VA. Aquaporin-4 autoimmunity. Neurol Neuroimmunol Neuroinflamm. 2015;2(4), e110.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Jarius S, Ruprecht K, Wildemann B, et al. Contrasting disease patterns in seropositive and seronegative neuromyelitis optica: a multicentre study of 175 patients. J Neuroinflammation. 2012;9:14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Pittock SJ, Lennon VA. Aquaporin-4 autoantibodies in a paraneoplastic context. Arch Neurol. 2008;65:629–32. An important observation that NMOSD could be a paraneoplastic disorder in some patients.

    PubMed  Google Scholar 

  75. Armagan H, Tuzun E, Icoz S, et al. Long extensive transverse myelitis associated with aquaporin-4 antibody and breast cancer: favorable response to cancer treatment. J Spinal Cord Med. 2012;35:267–9.

    Article  PubMed  PubMed Central  Google Scholar 

  76. De Santis G, Caniatti L, DeVito A, et al. A possible paraneoplastic neuromyelitis optica associated with lung cancer. Neurol Sci. 2009;30:397–400.

    Article  PubMed  Google Scholar 

  77. Frasquet M, Bataller L, Torres-Vega E, et al. Longitudinally extensive transverse myelitis with AQP4 antibodies revealing ovarian teratoma. J Neuroimmunol. 2013;263:145–7.

    Article  CAS  PubMed  Google Scholar 

  78. Al-Harbi T, Al-Sarawi A, Binfalah M, Dermime S. Paraneoplastic neuromyelitis optica spectrum disorder associated with stomach carcinoid tumor. Hematol Oncol Stem Cell Ther. 2014;7:116–9.

    Article  PubMed  Google Scholar 

  79. Yang HK, Woo SJ, Park W-Y, et al. Paraneoplastic neuromyelitis optica associated with ANNA-1 antibodies in invasive thymoma. BMC Ophthalmol. 2014;14:106.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  80. Zoccarato M, Saddi MV, Serra G, Pelizza MF, et al. Aquaporin-4 antibody neuromyelitis optica following anti-NMDA receptor encephalitis. J Neurol. 2013;260(12):3185–7.

    Article  PubMed  Google Scholar 

  81. Mueller S, Dubal DB, Josephson SA. A case of paraneoplastic myelopathy associated with the neuromyelitis optica antibody. Nat Clin Pract Neurol. 2008;4:284–8.

    Article  PubMed  Google Scholar 

  82. Figueroa M, Guo Y, Tselis A, et al. Paraneoplastic neuromyelitis optica spectrum disorder associated with metastatic carcinoid expressing aquaporin-4. JAMA Neurol. 2014;71:495–8.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Wong E, Vishwanath VA, Kister I. Rituximab in neuromyelitis optica: a review of literature. World J Neurol. 2015;5:39. Documents beneficial effects of Rituxmab in the majority of NMOSD patients.

    Article  Google Scholar 

  84. Pittock SJ, Lennon VA, McKeon A, et al. Eculizumab in AQP4-IgG-positive relapsing neuromyelitis optica spectrum disorders: an open-label pilot study. Lancet Neurol. 2013;12:554–602. First ever, highly successful clinical trial in NMO.

    Article  CAS  PubMed  Google Scholar 

  85. Araki M, Matsuoka T, Miyamoto K, et al. Efficacy of the anti-IL-6 receptor antibody tocilizumab in neuromyelitis optica: a pilot study. Neurology. 2014;82:1302–6. An important contribution to field of NMO therapeutics.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Kieseier BC, Stuve O, Dehmel T, et al. Disease amelioration with tocilizumab in a treatment-resistant patient with neuromyelitis optica: implication for cellular immune responses. JAMA Neurol. 2013;70:390–3.

    Article  PubMed  Google Scholar 

  87. Ayzenberg I, Kleiter I, Schroder A, et al. Interleukin 6 receptor blockade in patients with neuromyelitis optica nonresponsive to anti-CD20 therapy. JAMA Neurol. 2013;70:394–7.

    Article  PubMed  Google Scholar 

  88. Steinman L, Zamvil S. Re-engineering of pathogenic aquaporin 4-specific antibodies as molecular decoys to treat neuromyelitis optica. Ann Neurol. 2012;71:287–8.

    Article  PubMed  Google Scholar 

  89. Tradtrantip L, Zhang H, Saadoun S, et al. Antiaquaporin-4 monoclonal antibody blocker therapy for neuromyelitis optica. Ann Neurol. 2012;71:314–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. Verkman AS, Phuan PW, Asavapanumas N, Tradtrantip L. Biology of AQP4 and anti-AQP4 antibody: therapeutic implications for NMO. Brain Pathol. 2013 Nov;23(6):684–95.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dominique Rosales.

Ethics declarations

Conflict of Interest

Drs. Kister and Rosales declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Autoimmunity

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rosales, D., Kister, I. Common and Rare Manifestations of Neuromyelitis Optica Spectrum Disorder. Curr Allergy Asthma Rep 16, 42 (2016). https://doi.org/10.1007/s11882-016-0619-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11882-016-0619-4

Keywords

Navigation