Devic's neuromyelitis optica and pregnancy: distinction from multiple sclerosis is essential

Devic's neuromyelitis optica (NMO) is a severe neurological disease characterized by optic neuritis and transverse myelitis, which is commonly misdiagnosed as multiple sclerosis (MS). This rare syndrome has a poor prognosis, and there are very few cases described during pregnancy. We report the occurrence of NMO in a primigravida at 20 weeks, in which gestation had an adverse effect on the disease course, and emphasize the main parameters to distinguish NMO from MS. It is essential that a proper diagnosis is established before pregnancy is planned, since the prognosis for NMO and MS might differ. Although the association of gestation and NMO is extremely rare, the few available data demonstrate a significant risk of disease exacerbation. NMO patients require long term immunossupression and need to carefully evaluate the risk of getting pregnant.