Devic, syndrome
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(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