Non-MS Autoimmune Diseases of the Central Nervous System

The body’s immune system protects it against disease. If you have a neurological autoimmune disease, your immune system may be overly active and mistakenly attack healthy cells. The most common of these is multiple sclerosis (MS). There are several other inflammatory disorders of the nervous system that need specialized care.  At Mount Sinai, we have the expertise, experience, and resources to diagnose and treat these conditions. Our specialists can help you to improve your symptoms and quality of life.

Mount Sinai diagnoses and treats neurological autoimmune diseases other than MS. The following are the most common:

Neuromyelitis optica

If you have neuromyelitis optica (NMO), you may experience loss of vision in one or both eyes, weakness in the limbs, difficulty walking, and changes in sensation. You may also have a hard time controlling your bladder and bowels.

To diagnose NMO, we start with a medical history and physical exam. We also do blood work and a magnetic resonance imaging (MRI) scan. If we need more information, we may do a spinal tap, which involves removing some of your spinal fluid for testing. Treatment for NMO has some overlap with MS but also some important differences. For this reason, it is very important that you get the correct diagnosis. 

NMO has the potential to cause serious disability. But the right treatments are very helpful in preventing the disease from getting worse. We use medications that calm the immune system. There are a number of treatment options. For this reason, we will talk with you in detail about the potential benefits and risks of each one. This will help us develop a treatment plan just for you. 

Anti-myelin oligodendrocyte glycoprotein antibody disease (MOG)

The symptoms of anti-myelin oligodendrocyte glycoprotein (MOG) disease share some qualities with NMO and MS. There are also differences among the diseases. Symptoms include blurry vision, difficulty moving arms and legs, changes in sensation, loss of bladder control, and seizures. The diagnosis process is very similar to that of NMO. We do a physical exam, an MRI, and blood tests. Sometimes we perform a spinal tap.

The treatments are also similar—but not the same—as those for NMO and MS. We use medications to calm the immune system. We will talk with you about the options, so we can pick the approach that is best for you.

Autoimmune Encephalitis

When your body’s immune system attacks healthy brain cells, you may have autoimmune encephalitis. This condition causes the tissue of the brain and spinal cord to become inflamed.

We diagnose encephalitis and related conditions using a variety of methods:

  • Blood tests to see if you have a bacterial or viral infection
  • Brain imaging scans, such as magnetic resonance imaging (MRI) or electroencephalogram (EEG)
  • Spinal puncture, which removes a sample of cerebrospinal fluid for testing

We treat these conditions with various therapies including antiviral agents and anti-inflammatory agents.  We may also use therapeutic plasma exchange to remove harmful antibodies from the blood.

Additional Rare Neurological Autoimmune Diseases

Other conditions that we diagnose and treat include:

  • Acute disseminated encephalomyelitis (ADEM): This condition often follows a viral or bacterial infection. It causes fever, fatigue, headache, nausea, vomiting, and sometimes seizure and coma. We often treat this condition with steroids, plasmapheresis, or intravenous immunoglobulin therapy. Some people initially suspected to have ADEM go on to develop MS.
  • Chronic meningitis: Meningitis is an inflammation of the membranes around your brain and spinal cord. Chronic meningitis develops slowly and lasts at least four weeks.  We diagnose the condition with imaging scans, including magnetic resonance imaging and computed tomography. Treatment options vary, but we often use broad-spectrum antibiotics.
  • Central nervous system (CNS) vasculitis: In this condition, the immune system attacks the blood vessels. You may experience severe headaches, forgetfulness or confusions, problems with your vision, seizures, or mini strokes. We diagnose CNS vasculitis using blood tests, MRI, and blood vessel scans. Treatment usually includes steroids.
  • Hashimoto’s encephalitis: This includes several autoimmune disorders that usually affect women who are about 50 years of age. We make a diagnosis using MRI, EEG, cerebrospinal fluid analysis, hormonal and metabolic blood screens, and viral studies. Usually, we treat Hashimoto’s encephalitis with high-dose steroids. Treatment can take a few days to many months.
  • Steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT): This condition causes memory issues, confusion, convulsions, speech difficulties, and paranoid delusions. We treat SREAT with steroids and other medications.
  • Neurosarcoidosis: In this condition, you develop areas of inflammation in the brain and spinal cord. It can cause weakness in your face muscles, headaches, difficulties with your vision and hearing, memory loss, hallucinations, and mood changes. We usually treat the condition with steroids and other medications to treat inflammation.
  • Optic neuritis: This condition causes the nerves in your eyes to become inflamed. It can cause pain and temporary vision loss.  You may also lose the ability to see colors, or you may notice flashing or flickering lights. We diagnose optic neuritis through a regular eye exam, blood tests, and magnetic resonance imaging scans. We treat optic neuritis with medication to reduce inflammation.
  • Transverse myelitis: Usually caused by an infection, transverse myelitis is inflammation of the spinal cord. You might experience weakness in your arms or legs, pain in your lower back, or dysfunction with your bladder or bowel; you might need to urinate more or may have difficulty going to the bathroom. We diagnose the condition using an MRI, blood work, and lumbar punctures, which allow us to remove a small amount of spinal fluid for testing. We treat transverse myelitis with corticosteroids, plasma exchange therapy, intravenous immunoglobulin, and other medications.