Disclosures: Catherine A. Mills, MD: No financial relationships or conflicts of interest

Case Description: Case 1: 67 yo woman with NMO with early relapse in the setting of delayed initiation of rituximab, presents nearly 2 years later with urinary incontinence, chest and leg numbness, and gait instability. Treatment included steroids and plasmapheresis. She was discharged to an Inpatient Rehabilitation Facility (IRF) with plan to resume rituximab. Case 2: 37 yo man presented with blurred vision, pain and weakness in bilateral arms, numbness in bilateral legs, and urinary dysfunction. Symptoms rapidly progressed to near complete BLE plegia. Imaging was consistent with longitudinally extensive transverse myelitis and bilateral optic neuritis. He was diagnosed with NMO and treated with steroids and plasma exchange; rituximab was initiated prior to discharge to IRF.

Setting: Inpatient rehabilitation facility (IRF)

Patient: 67 yo woman and 37 yo man with neuromyelitis optica (NMO) Assessment/

Results: Case 1: Noted to have significant right-sided lower extremity weakness and sensory deficits. She was fitted with an AFO and, within one week of admission for comprehensive rehabilitation, progressed to contact guard to supervision for functional mobility and transfers. Parasthesias were slower to improve. Case 2: Diagnosed with a T4 ASIA D injury, he completed 6 weeks of comprehensive rehabilitation. Upon discharge, he had progressed to modified independence with functional mobility with bilateral forearm crutches and minimum assistance with activities of daily living (ADLs). His vision also improved.

Discussion: NMO is a rare demyelinating disease of the central nervous system (CNS), which until recently was thought to be a subtype of Multiple Sclerosis (MS). NMO has a more rapid course than MS, leaving patients with an increased level of disability. Early recognition and treatment are critical to prevention of progression. Referral to rehabilitation early in the course may help patients better adapt and maintain independence.

Conclusion: NMO is a severe and rapidly debilitating disease. Rehabilitation may improve quality of life and prolong independence.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/neuromyelitis-optica-a-case-series/