Dave Anandi R, Shamal Snehal S, Sharath H V
Department of Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND.
Department of Paediatric Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND.
Cureus. 2024 Jun 17;16(6):e62512. doi: 10.7759/cureus.62512. eCollection 2024 Jun.
Devic's disease, also known as neuromyelitis optica (NMO), is an uncommon autoimmune condition that affects the optic nerves and spinal cord. It is characterized by recurrent optic neuritis and myelitis, which can cause paralysis and visual impairment. Because NMO mimics multiple sclerosis, diagnosing it is difficult and necessitates particular testing, such as magnetic resonance imaging (MRI) and aquaporin-4 antibody detection. Patients with NMOs are susceptible to severe, erratic episodes that can result in rapid impairment. As such, timely and efficient therapy with immunosuppressive medicines and continued supportive care are crucial. Improving mobility, strength, coordination, and quality of life while treating the functional deficiencies associated with NMOs requires the use of physiotherapy. This case study emphasizes how crucial it is to manage a young NMO patient using a multidisciplinary strategy in order to maximise results. This case report discusses a 16-year-old male presenting with a sudden onset of balance impairment, slurred speech, difficulty walking and breathing, and weakness in limbs, with the right side more affected. Over three months, he experienced increasing eyesight issues, fatigue, tremors during activities of daily living, difficulty swallowing, and night cramps. Diagnostic investigations including MRI, angiography, visual evoked potentials (VEP) study, and cerebrospinal fluid (CSF) analysis confirmed demyelinating changes consistent with NMO, also known as Devic's disease. The patient received management with steroidal medications, immunosuppressants, and plasma therapy, along with physiotherapy rehabilitation. The physiotherapy protocol aimed to address muscle weakness, coordination impairment, balance issues, fine motor deficits, fatigue, sensory impairment, and dependence on activities of daily living. Motor, sensory, and cranial nerve assessments were conducted, revealing impairments consistent with NMO. Outcome measures pre- and post-intervention showed improvements in functional independence, balance, and fatigue severity. The medical management included a combination of medications and investigations to manage NMO symptoms and monitor disease progression. The physiotherapeutic approach employed a multidisciplinary strategy focusing on education, exercise, and functional tasks to improve the patient's quality of life and independence.
视神经脊髓炎谱系疾病（Devic病），也称为视神经脊髓炎（NMO），是一种罕见的自身免疫性疾病，会影响视神经和脊髓。其特征是复发性视神经炎和脊髓炎，可导致瘫痪和视力障碍。由于NMO与多发性硬化症相似，因此诊断困难，需要进行特殊检查，如磁共振成像（MRI）和水通道蛋白-4抗体检测。NMO患者易发生严重、不稳定的发作，可导致迅速的功能损害。因此，及时有效地使用免疫抑制药物治疗并持续给予支持性护理至关重要。在治疗与NMO相关的功能缺陷时，利用物理治疗来改善活动能力、力量、协调性和生活质量。本病例研究强调了采用多学科策略管理年轻NMO患者以实现最佳效果的重要性。本病例报告讨论了一名16岁男性，他突然出现平衡障碍、言语含糊、行走和呼吸困难以及肢体无力，右侧受影响更严重。在三个月的时间里，他出现了视力问题加重、疲劳、日常生活活动时震颤、吞咽困难和夜间抽筋。包括MRI、血管造影、视觉诱发电位（VEP）研究和脑脊液（CSF）分析在内的诊断性检查证实了与NMO（即Devic病）一致的脱髓鞘改变。患者接受了类固醇药物、免疫抑制剂和血浆治疗，以及物理治疗康复。物理治疗方案旨在解决肌肉无力、协调障碍、平衡问题、精细运动缺陷、疲劳、感觉障碍以及对日常生活活动的依赖。进行了运动、感觉和颅神经评估，发现了与NMO一致的损伤。干预前后的结果指标显示功能独立性、平衡和疲劳严重程度有所改善。药物治疗包括联合使用药物和进行检查以控制NMO症状并监测疾病进展。物理治疗方法采用多学科策略，重点是教育、锻炼和功能性任务，以提高患者的生活质量和独立性。
