Double-Negative Neuromyelitis Optica Spectrum Disorder

French guidelines for the diagnosis and management of neuromyelitis optica spectrum disorder.

Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the central nervous system, characterized by severe attacks. Optic neuritis is the most common clinical manifestation, leading to a rapid and often severe loss of vision, which is sometimes bilateral, with frequent sequelae and a risk of very low visual acuity in the long-term. Magnetic resonance imaging (MRI) reveals extensive lesions of the optic nerve, mostly involving the posterior part of the nerve and sometimes extending to the optic chiasm. Myelitis manifests as longitudinally extensive and centrally located spinal cord lesions, which may lead to tetraplegia, sensory disturbances, neuropathic pain and sphincter dysfunction. Area postrema syndrome presents with nausea, vomiting, and severe hiccups, which are often resistant to conventional treatments and may require hospitalization. Diagnosis is confirmed by the detection of anti-aquaporine 4 (AQP4) antibodies in the serum. Attacks should be treated as an emergency, with intravenous (IV) corticosteroids and plasma exchange, without waiting for antibody confirmation. Maintenance therapy includes monoclonal antibodies targeting B lymphocytes, interleukin-6 receptor, complement C5 and non-selective immunosuppressive treatments, according to profile of tolerance. Conventional treatments such as azathioprine or mycophenolate are less commonly used as first-line therapies but remain possible depending on the clinical context. Follow-up is multidisciplinary, with neurological, and according to the symptoms ophthalmological, neuropsychological, urodynamic or sequellar disability consultations. Therapeutic patient education and support from patient organizations are essential for improving quality of life and treatment adherence. Pregnancy is considered high-risk, requiring regular neurological and obstetric monitoring, as the risk of attack increases in the postpartum period. Finally, the rapid and individualized management of attacks as well as the prevention of relapses is crucial to limit functional sequelae and disability.

Age-stratified clinical characteristics and disability outcomes in neuromyelitis optica spectrum disorder: A cross-sectional study.

Neuromyelitis Optica Stabilized through Dharma

Neuromyelitis Optica Spectrum Disorder (NMOSD) is a rare autoimmune disease of the central nervous system characterized by recurrent relapses and progressive neurological disability. This paper presents the case of a woman with a history of NMOSD spanning more than 30 years who experienced sustained clinical stability after adopting the Five Golden Buddhist Practices of Guan Yin Citta Dharma Door. Prior to her Buddhist practice, she reported relapses approximately once every three years. Over the subsequent four years of consistent practice, she reported no further relapses and experienced marked improvements in overall health and quality of life. The case is analyzed from both biomedical and Dharma perspectives. Contemporary medicine attributes NMOSD primarily to autoimmune mechanisms involving aquaporin-4 (AQP4) IgG antibodies and immune dysregulation. In contrast, Dharma teachings frame illness as potentially rooted in karmic causes. In this case, the patient’s history of abortion, assisting others with abortions, sexual misconduct, involvement in the sex-related product industry, and consumption of pornographic material are identified as possible sources of negative karma that may have contributed to her condition. This case suggests that Dharma-based spiritual practices may offer potential benefits as a complementary approach for some individuals with NMOSD. Further systematic investigation is warranted to explore these observations.

Diagnostic features of the neuromyelitis optica spectrum disorders in real clinical practice

Neuromyelitis optica spectrum disorders (NMOSD) constitute a group of rare, autoimmune and often disabling diseases of the central nervous system. Despite clear diagnostic criteria for NMOSD, diagnostic errors remain a serious problem, leading to delays in necessary treatment and adverse outcomes. This article presents four clinical cases of NMOSD that illustrate the difficulties in making a timely diagnosis due to an ambiguous clinical, radiological and laboratory picture. In these cases, clinical manifestations typical of NMOSD (optic neuritis, acute myelitis and area postrema syndrome) are described; however, the patients were initially referred to specialists in other fields: ophthalmologists, gastroenterologists and neurosurgeons, which led to a delay in their referral to the Multiple Sclerosis Centre and a late diagnosis. The delayed initiation of pathogenetic therapy in two patients led to the development of persistent severe disability as a consequence of NMOSD exacerbations. Factors contributing to the prolonged time to diagnosis were analyzed, and strategies to improve the early diagnosis of NMOSD to prevent such outcomes were proposed.

Use of Fluid Biomarkers in NMOSD and MOGAD

A review of current evidence on established and emerging fluid biomarkers in NMOSD and MOGAD, with emphasis on analytical performance, biological relevance, and clinical utility, and outlines priorities for future research.

Clinical and serological features of systemic autoimmune overlap in AQP4-IgG positive neuromyelitis optica spectrum disorder: a Mexican cohort study.

Systemic autoimmune overlap was present in approximately one in five patients and the overlap group showed more frequent systemic autoantibody positivity and a predominance of optic neuritis at onset, but disability measures, treatment patterns, and most clinical outcomes were similar between groups.