The Clinical Pearls for Diagnosing and Treating NMOSD: Brian G. Weinshenker, MD, FRCP


The professor of neurology at the University of Virginia talked about the improvement and areas of unmet need in the diagnosis and treatment for neuromyelitis optica spectrum disorder. [WATCH TIME: 6 minutes]

WATCH TIME: 6 minutes

"I showed a case of a spinal cord disorder, a longitudinally extensive spinal cord lesion that caused raised intracranial pressure and substantial visual loss in a patient. Neuromyelitis optica was suspected, but it turned out it was a spinal cord glioma that was proven on biopsy and caused this raised intracranial pressure, and that was the cause of the blurred vision."

Neuromyelitis optica spectrum disorder (NMOSD) is a rare inflammatory central nervous system disorder that is clinically distinctively different from multiple sclerosis (MS). Treatment for the disease was made possible through the detection of serum antibodies that target the water channel aquaporin-4 (AQP4). Thus, the AQP4-IgG serology became incorporated into the diagnostic criteria for NMOSD and confirmed in various ethnic and racial cohorts globally, becoming the standard for clinical and research purposes.1

Since then, advances in the field have made the standard criteria inadequate for clinicians to use in contemporary research and medical practice. According to a prior publication in Neurology, the term NMOSD has also been used variably in studies and needs further clarification as some patients may be diagnosed with seronegative NMOSD.1 Other issues that may stand out beside seronegative patients include the exploration of distinctive features of NMOSD in pediatric patients. Treatment strategies to prevent relapse attacks in NMOSD significantly differ from those used in MS and therefore, it may be critical for clinicians to make an accurate diagnosis to intervene early and not aggravate the disease.

Brian G. Weinshenker, MD, FRCP, professor of neurology at the University of Virginia, presented a talk on diagnostic pearls in NMOSD at the 2024 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 29 to June 1, in Nashville, Tennessee. At the meeting, Weinshenker sat down in an interview with NeurologyLive® to further discuss the primary biomarker used for diagnosing NMOSD in the clinic. He also talked about how atypical presentations of NMOSD complicate the diagnosis. Furthermore, Weinshenker explained why it is a challenge to diagnosis and treat patients with seronegative NMOSD.

Click here for more coverage of CMSC 2024.

1. Wingerchuk DM, Banwell B, Bennett JL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85(2):177-189. doi:10.1212/WNL.0000000000001729
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