Neuromyelitis optica spectrum disorder (NMOSD): A new concept

The relationship between neuromyelitis optica (NMO) and multiple sclerosis (MS) has long been controversial. NMO was previously considered a form of MS involving predominantly the spinal cord and optic nerve. However, since the discovery of NMO-IgG/aquaporin-4 (AQP4) antibody, an NMO-specific autoantibody to AQP4, some unique clinical features, and magnetic resonance imaging (MRI) and other laboratory findings in NMO, have been further clarified. AQP4 antibody is now the most important laboratory finding for the diagnosis of NMO. Besides typical NMO, some patients with recurrent optic neuritis or recurrent longitudinally extensive transverse myelitis alone are also often positive for AQP4 antibody. Moreover, studies of AQP4 antibody-positive patients have revealed that brain and brainstem lesions are not uncommon in NMO, and some patterns appear to be unique to NMO. All these findings have expanded the NMO concept into 'NMO spectrum disorder' (NMOSD), and new criteria have recently been published. A new antigenic target, myelin oligodendrocyte glycoprotein (MOG), has also been discovered recently. This new antibody seems to correspond to around 20% of seronegative patients, but its specificity needs to be evaluated more precisely, especially in pediatric populations. These recent findings may also have therapeutic impact, as it has been demonstrated that many MS drugs can exacerbate NMO. This report provides an overview of the clinical and neuroimaging features of NMOSD, followed by its treatment.