• In a demyelinating disease, the myelin sheath that protects the fibers in the central nervous system (brain, optic nerves, and spinal cord) is damaged due to an attack on the immune system. When this happens, it causes the nerve impulses to slow down, impacting the body’s function, or even stop, leading to symptoms that include paralysis and sensory loss.

1. Optic neuritis
2. Acute disseminated encephalomyelitis (ADEM)
3. Anti MOG antibody associated disorder
4. Neuromyelitis Optica (NMO)
5. Transverse Myelitis
6. Multiple sclerosis

• Sudden onset and rapidly progressive reduced vision/ blindness in one or both eyes

• Weakness or paralysis in arms and legs

• Impaired consciousness, coma, and/or seizures

• Inability to pass urine and/or sense full bladder

• Loss of body sensation

• Uncontrollable vomiting or hiccups

It is diagnosed based on clinical history, examination, opthal evaluation, MRI brain and spine, CSF study, and certain blood tests (NMOSD antibody).

Treatment includes, methylprednisolone injection for 3-5 days and followed by tapering schedule of oral steroids. Second line immunomodulation in form of rituximab, cyclophosphamide, mycophenolate requires to prevent further recurrent attacks.