Silent burden: recognising and managing invisible symptoms in neuromyelitis optica

Aquaporin-4-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) is an autoimmune astrocytopathy primarily characterised by visual, motor, and sensory symptoms, depending on lesion location. However, patients frequently experience invisible symptoms such as fatigue, pain, neuropsychiatric symptoms, and bladder/bowel dysfunction, which are often overlooked despite their substantial impact on quality of life. A systematic literature review was conducted using PubMed, with keywords related to fatigue, pain, bladder/bowel dysfunction, and neuropsychiatric symptoms in the context of AQP4+NMOSD. The review explores the prevalence, assessment, and management of these frequently neglected symptoms. There is a critical need for improved detection and monitoring of invisible symptoms in AQP4+NMOSD. Enhanced assessment is crucial not only for developing targeted therapies but also for determining whether these symptoms reflect underlying disease activity, ultimately leading to optimised treatment strategies.