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Patients with NMOSD can exhibit different relapse symptoms but there is no consistent standard for measuring relapse severity, leading to inconsistent treatment.

Among patients with NMOSD, many can experience relapse symptoms of varying severity and frequency. Additionally, stable patients can experience differing levels of disability and visual acuity. These can vary depending on many factors, and researchers are still attempting to better understand the factors associated with high levels of disability or relapse severity. 

This study, published in the journal Neurology and Therapy, provides insights into relapse severity on the basis of neurologist reports from around the world. Information on demographics, maintenance therapy, and disease stability, along with firsthand reports from patients, were used to more accurately assess relapse risk and disability progression among patients with NMOSD.

Analyzing NMOSD Relapse Severity on a Large Scale

Records from a total of 1185 patients with aquaporin-4-immunoglobulin G (AQP4-IgG)-seropositive adults with NMOSD were obtained, and 33 patients were interviewed later on as part of the study. Clinical practices globally did not agree on how to define relapse severity, and geographical variations in relapse classification also appeared in the data. The data show that neurologists usually rely on their clinical assessment to determine how severe a relapse is, and they don’t compare relapses in any systematic way, but treat each in isolation.

Patients Care More About Disability Effects Than Clinical Outcomes

In contrast, patients who were interviewed were primarily concerned with changes to their daily lives and seemed to primarily view stability on the basis of the absence of relapses, rather than other clinical factors. These patient-focused assessments are an important area of study because they allow researchers to understand which aspects of their disease and disability patients feel need to be addressed urgently.

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Clear Guidelines are Needed for Assessing NMOSD Relapses

Because no international guidelines currently exist for evaluating relapse severity, patients can receive different treatment on the basis of factors that aren’t related to the clinical presentation of their disease. Reaching a consensus that can allow researchers and clinicians to use the same metrics when treating and evaluating patients with NMOSD can make treatment more uniform, and guarantee that treatment and research are consistent internationally. Additionally, factoring in patient-reported areas of importance can make disability outcomes better for patients, as they will be able to focus on interventions that prioritize the way that their daily lives are affected by their NMOSD symptoms.


Capobianco, M., Ringelstein, M., Welsh, C., Lobo, P., deFiebre, G., Lana-Peixoto, M., Wang, J., Min, J. H., & Wingerchuk, D. M. (2023). Characterization of Disease Severity and Stability in NMOSD: A Global Clinical Record Review with Patient Interviews. Neurol Ther, 12(2), 635-650. https://doi.org/10.1007/s40120-022-00432-x