What NMOSD is
NMOSD is an inflammatory disorder of the central nervous system, most often associated with antibodies against aquaporin-4 (AQP4-IgG). It can affect the optic nerves, the spinal cord, the brainstem and, less commonly, the brain.
Typical attacks include painful vision loss, weakness or numbness in the legs, bladder or bowel dysfunction, and severe vomiting or hiccups from area postrema involvement. MOG antibody-associated disease (MOGAD) is a related but distinct condition.
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Why the distinction from MS matters
Some medicines used for multiple sclerosis can worsen NMOSD, so accurate diagnosis is essential. NMOSD is suggested by severe or bilateral optic neuritis, longitudinally extensive spinal cord lesions, area postrema syndrome and AQP4-IgG positivity.
A negative antibody test does not always exclude NMOSD. The diagnosis combines the clinical syndrome, MRI findings and antibody results, and may need repeat testing or specialist neuroimmunology review.
- Severe or bilateral optic neuritis
- Spinal cord lesion extending over three or more segments
- Persistent hiccups, nausea or vomiting without another cause
- AQP4-IgG or MOG-IgG testing
- Review of previous MRI and treatment response
Diagnosis
MRI of the brain, orbits and spinal cord with contrast is central. Optical coherence tomography and visual fields help quantify optic nerve damage. Lumbar puncture may show pleocytosis or oligoclonal bands, but it is not required in every case.
Blood tests for AQP4-IgG and MOG-IgG are sent to a reliable laboratory. Thyroid disease, vitamin B12 deficiency, infection, sarcoidosis and other autoimmune conditions are considered as alternatives or co-existing problems.
Treatment and relapse prevention
Acute attacks are treated urgently with high-dose intravenous corticosteroids. Plasma exchange may be used when the attack is severe or steroids are not effective, where the service is available.
Long-term relapse prevention may include rituximab, azathioprine, mycophenolate or newer complement and IL-6 targeted therapies where available and appropriate. Treatment is chosen according to antibody status, disease course, pregnancy plans, infection risk and access.
Rehabilitation, bladder and bowel care, spasticity management, pain control, vision rehabilitation and psychological support are part of long-term care. Pregnancy should be planned with the neurology team because relapse risk changes during and after pregnancy.
Access and booking
Appointments are at Kathmandu Neurology Clinic & Cognitive Center, 117 Lal Durbar Marg, Kathmandu, opposite Yak & Yeti Hotel. Call +977-9747736624 or use /book-appointment. Bring prior reports, imaging and a medication list.