Neuromyelitis optica spectrum disorder: a 5-year experience in a tertiary hospital in Northern Vietnam

Neuromyelitis optica spectrum disorder (NMOSD) is a rare, severe autoimmune disease of the central nervous system more prevalent in African and Asian ancestries. The data within the Vietnamese community remain limited.

To evaluate the clinical, laboratory, and radiological profiles of a Vietnamese NMOSD cohort, identifying patterns of diagnostic delays, misdiagnosis, and immunotherapy adherence.

This retrospective study re-evaluated patients admitted to a tertiary hospital from January 2019 to August 2024 meeting the 2015 diagnostic criteria. Data were collected from records, phone interviews, or follow-ups.

We identified 40 patients with 106 disease attacks (73 documented). The female-to-male ratio was 39:1; mean onset age was 44.83 ± 14.07 years. Transverse myelitis was most common initially (57.5%) and overall (63.6%). Aquaporin-4 antibody was positive in 91.9%. Longitudinally extensive transverse myelitis appeared in 83.7% of abnormal spinal MRIs; brain MRI abnormalities in 74%. Only 20% of patients received an accurate etiological diagnosis at onset, with a mean diagnostic delay 24.15 ± 41.1 months. Relapses occurred within the first year in 60% of patients, and within five years in 83.3%. Preventive treatment was prescribed to 85%; long-term adherence was 60% with rituximab showing the highest adherence (15 patients).

NMOSD in Vietnamese patients features a marked female predominance, prominent spinal cord involvement, high relapse rates, and low accurate etiological diagnosis rates at onset. Long-term treatment non-compliance, limited antibody test availability, and low physician awareness likely remain major clinical challenges.