Author Affiliations: Department of Neurology, University of Texas Southwestern Medical Center, Dallas (Dr Greenberg); Department of Neurology, Mayo Clinic, Scottsdale, Arizona (Dr Wingerchuk); and Department of Neurology, Johns Hopkins Hospital, Baltimore, Maryland (Ms Mealy and Dr Levy).
We appreciate the comments of Drs Govindarajan and Salgado relative to our article about the clinicopathologic spectrum of neuromyelitis optica (NMO)/NMO spectrum disorder. They point out 2 other potential clinical manifestations of NMO and question the conclusions relative to natalizumab and interferon therapy.
The cases presented do indeed represent potential presentations for NMO. The first case describes a patient who presented with clinical and radiographic evidence of myeloradiculitis and whose test results were subsequently found to be positive for the anti–aquaporin 4 (AQP4) antibody. The second case involves a patient with generalized pruritus preceding myelitis and whose test results were positive for anti-AQP4 antibody. While our case series did not specifically record these patient types, it is worth noting 2 observations.
Greenberg BM, Wingerchuk D, Mealy M, Levy M. What Is the True Clinicopathologic Spectrum of Neuromyelitis Optica?—Reply. JAMA Neurol. 2013;70(2):272–273. doi:10.1001/jamaneurol.2013.1286