Clinical Characteristics Of 21 Patients With Optic Neuromyelitis

Objective:To study the general clinical characteristics of NMO,and TCM etiology and pathogenesis and syndrome type distribution.Methods:Collect the patients with neuromyelitis optica who has been hospitalized in Dongfang hospital from January 2010 to December 2014 in the Department of Ophthalmology and encephalopathy.Select the medical records which met the inclusion criteria,collect elevant nformation according to the "information gathering table",analysis and induction, summed up the characteristics.Results:21patients were in the group.The male to female ratio was 1:2, from age 8 to 51 years old, the average age was 29.67+11.61 years.47.6% patients had definite precipitating factors in the pathogenesis and recurrence, the most common of which is upper respiratory tract infection.The average recurrence times during a year is 1.37.With the increased period of patients followed up, generally showed an slowed down trend of recurrence. Of all the ocular symptoms,the most common is the "eyesight to drop",followed by"visual field defect", "eye pain or rotating pain". Of the neurological expression, the most common is the numbness of limbs or trunk in 13 cases (occupied with nervous system symptomsnumber 72.2%),4 cases of pain in the trunk or limbs (22.2%).Visual mpairment of NMO s heavy,as the disease progresses, progressive impairment of vision happens, most of the patients in the acute phase experienced a visual acuity recovery after the glucocorticoid therapy, but the overall downward trend is apparent, serious person can be reduced to no light perception.About the visual field examination,14 eyes didn’t check visual field examination due to impaired vision,of the other 25 eyes, the average of MD (18.2+9.1) dB, "diffuse defect" the highest proportion of the visual field abnormalities.In MRI manifestations, cervical involvement is the most common,about 9 cases(52.9%), the most affected areas are C3-C5, accounting for the total involvement of the 70% cervical segment.Followed by cervical vertebra and thoracic vertebra joint involvement,about 6 cases (35.3%), the most susceptible areas are C7-T4, accounting for 71.4%.TCM:Syndrome type is mainly divided into five groups:liver and kidney deficiency,Qi stagnation and blood stasis,Qi and blood deficiency,hyperactivity of fire due to yin deficiency, toxin filled,of which the type of deficiency of liver and kidney was the most common.Liver and kidney deficiency and hyperactivity of fire due to yin deficiency recurrence times and involved segments were more.Qi stagnation and blood stasis syndrome is more common in young people,the distribution of impaired eyesight was polarized, but overall was lighter than other types.The type of Qi and blood deficiency was lower at aspects of recurrence times and spinal-cordinvolvement,the illness is lighter.Although the type of toxin filled recurrence is less frequency, but accumulated the largest segment of spinal cord.The type of liver and kidney deficiency,numbness of limbs or trunk accounted for a larger proportion,pain of body were more common of the qi stagnation and blood stasis and Qi and blood deficiency,hyperactivity of fire due to yin deficiency is mainly reflected in the limb weakness, numbness,pain, belt feeling were seen in the type of toxin filled.In view of the different types of syndrome, treatment also respectively.Among them, the Six-Ingredient Pill with Rehmannia is for the deficiency of liver and kidney,Taohong Siwu Decoction is mainly for the Qi stagnation and blood stasis,Eight treasures Decoction is for the deficiency of Qi and blood,hyperactivity of fire due to yin deficiency with Zhibai Dihuang Wan,treat toxinis filled type with five-Ingredient Decoction to Eliminate Toxin.Conclusion:NMO is an idiopathic CNS inflammatory demyelinating disease. Mainly involving the optic nerve and spinal cord, manifested as monocular or binocular vision decline or even blindness, spinal cord lesion showed transected spinal cord injury. The incidence of NMO is influenced by race, gender and age factors. Women seen more, the peak age of onset is in the 20-40s,47.6% of patients had definite precipitating factors in the pathogenesis and recurrence,early respiratory infections were the most.The spinal cord MRI findings of NMO shows that the cervical involvement is most common,and the most vulnerable areas are C3-C5,also accompany with intracranial lesions.The location of NMO is in the spinal cord and the eye,and deficiency in origin and excess in superficiality: deficiency of the liver,spleen and stomach, kidney damage is the internal basis, Exogenous factors are superficially, pulmonaryscorched by heat, damp heat toxin, phlegm and blood stasis resistance are external conditions.Type is mainly divided into five groups:liver and kidney deficiency,Qi stagnation and blood stasis, Qi and blood deficiency,hyperactivity of fire due to yin deficiency,toxin filled.Each type has its clinical manifestations and treatment characteristics.