Exploring core symptoms and symptom clusters among patients with neuromyelitis optica spectrum disorder: A network...

To identify core symptoms and symptom clusters in patients with neuromyelitis optica spectrum disorder (NMOSD) by network analysis.

From October 10 to 30, 2023, 140 patients with NMOSD were selected to participate in this online questionnaire survey. The survey tools included a general information questionnaire and a self-made NMOSD symptoms scale, which included the prevalence, severity, and distress of 29 symptoms. Cluster analysis was used to identify symptom clusters, and network analysis was used to analyze the symptom network and node characteristics and central indicators including strength centrality (r _s), closeness centrality (r _c) and betweeness centrality (r _b) were used to identify core symptoms and symptom clusters.

The most common symptom was pain (65.7%), followed by paraesthesia (65.0%), fatigue (65.0%), easy awakening (63.6%). Regarding the burden level of symptoms, pain was the most burdensome symptom, followed by paraesthesia, easy awakening, fatigue, and difficulty falling asleep. Six clusters were identified: somatosensory, motor, visual, and memory symptom clusters, bladder and rectum symptom clusters, sleep symptoms clusters, and neuropsychological symptom clusters. Fatigue (r _s = 12.39, r _b = 68.00, r _c = 0.02) was the most central and prominent bridge symptom, and motor symptom cluster (r _s = 2.68, r _c = 0.10) was the most central symptom cluster among the six clusters.

Our study demonstrated the necessity of symptom management targeting fatigue, pain, and motor symptom cluster in patients with NMOSD.