Biggest Advances in NMOSD Management, Diagnosis: Brian G. Weinshenker, MD

"Things really changed with the discovery of the biomarker, AQP4-IgG. This made us a lot more confident and allowed us to recognize a much broader spectrum of the disease than we had previously appreciated.”

Neuromyelitis optica spectrum disorder (NMOSD) is a chronic disorder of the brain and spinal cord dominated by inflammation of the optic nerve and inflammation of the spinal cord. Patients who meet the criteria for NMOSD experience repeated attacks separated by periods of remission, like multiple sclerosis (MS), its commonly confused mimic. Diagnosing these patients entails a thorough clinical evaluation, identification of characteristic physical findings, and a variety of specialized tests including cerebrospinal fluid, spinal taps, MRI, or CT scans.

A blood test, AQP4-IgG, is highly specific and moderately sensitive for NMOSD, and has shown that it detects antibodies that are specific for an astrocyte protein, aquaporin-4. There are currently 3 standard FDA-approved therapies, including eculizumab (Soliris; Alexion), inebilizumab (Uplinza; Viela Bio), and satralizumab (Enspryng; Chugai/Roche), which are all indicated for patients who are AQP4 antibody positive.

Among the several strides made within the space since the turn of the century, none may be bigger than the diagnostic capabilities and recognition of the disease, according to Brian G. Weinshenker, MD. Weinshenker, professor of neurology at the Mayo Clinic College of Medicine, recalls a time where clinicians argued whether the disease was an independent. He sat down with NeurologyLive to provide his thoughts on some of the more notable findings in recent years that have propelled the understanding of NMOSD.