The first, and probably, the most frequent effort on the
daily practice of neurologists is to differentiate NMOSD from
MS22. Usually, NMOSD patients have more frequently a nonCaucasian
ancestry, and an average age at onset higher than
MS patients. NMO attacks are more severe and despite the
efforts to treat aggressively the NMO attacks, many patients
are left with permanent visual or motor incapacity1,23.
Persistent (duration .48 hours) or intractable nausea, vomiting
and hiccups are found in about 30% of NMOSD
patients due to brainstem attacks8 and these symptoms
are not reported at all in MS. Bilateral hypothalamic lesions
seems also to be something only found in NMOSD patients,
and these lesions may cause sleep disturbances such as narcolepsy
and may be associated with low hypocretin levels in
the cerebrospinal fluid (CSF24). Painful tonic spasms during
myelitis recovery and severe pain are found in NMOSD more
commonly than in MS25,26. Neuropathic pruritus (itch) ha