Devic, syndrome

(Neuromyelitis Optica)

Rare: 1-9/100,000, more frequent in girls and women (3: 1).  Central nervous system demyelinating inflammatory disease combining acute optic neuritis and  acute myelitis due to the presence of  anti-aquaporin 4 antibodies. For a long time regarded as a particular form of multiple sclerosis. Average age of onset: 40 years but pediatric forms have been reported.

Retrobulbar, uni - or bilateral, optical neuritis. Spinal cord impairment causes back pain followed by motor, sensory and sphincter disorders.

Sometimes associated with other autoimmune as diseases: systemic lupus erythematosus, myasthenia gravis, Sjögren disease. 

Treatment: acute phase: corticosteroids, immunosuppressants, sometimes plasmapheresis.


Anesthetic implications: 

risk of autonomic response in case of stimulation in the area innervated by the affected spinal segment; visual impairment; controversial contra-indication to a  neuraxial block.


References : 

-         Gunaydi K, Akcali D, Alkan M. 
Epidural anesthesia for caesarian section in a patient with Devic’s syndrome. 
Anaesthesia 2001; 56: 565-7.

-         Sadana N, Orosco M, Farber M, Segal S. 
Perioperative management of a parturient with neuromyelitis optica. 
Cleveland Clin J Med 2010; 77; ES 1 eS49.

-         Hosseini  H, Brugières P, Degos DD, Cosaro P. 
Neuromyelitis optica after a spinal anesthesia with bupivacaine. 
Mult Scler 2003; 9: 526-8. 

-         Facco E, Giorgetti R, Zanette G. 
Spinal anesthesia and neuromyelitis optica: cause or coincidence? 
Eur J Anesthesiol 2010; 27: 578-80.


Updated: August 2019