NMOSD has a heterogenous presentation, potentially complicating diagnosis1

Initial presentation typically includes 1 or more hallmark clinical features in the optic nerve, spinal cord, and/or the brain or brain stem1

Transverse myelitis Spine icon Transverse myelitis Spine icon Transverse myelitis Spine icon

~50% of cases involve transverse myelitis1

Common debilitating symptoms associated with transverse myelitis include2,3

  • Lhermitte’s phenomenon
  • Intractable pain
  • Bladder and bowel dysfunction
  • Weakness and paralysis
  • Loss of sensation
  • Paroxysmal tonic spasms of the trunk and limbs
Optic Neuritis Eyeball icon Optic Neuritis Eyeball icon Optic Neuritis Eyeball icon

~35% of cases involve optic neuritis1

Common debilitating symptoms associated with optic neuritis include2,3

  • Ocular pain
  • Unilateral and bilateral loss of visual acuity, leading to blindness
Transverse myelitis and optic neuritis icon Transverse myelitis and optic neuritis icon Transverse myelitis and optic neuritis icon

~10% of cases involve transverse myelitis & optic neuritis1

Area postrema syndrome icon Area postrema syndrome icon Area postrema syndrome icon

~4% of cases involve area postrema syndrome, cognitive impairment, or respiratory failures1-3

Symptoms with brain and brain stem involvement include2,4

  • Nausea
  • Vomiting
  • Intractable hiccups

MRI is an essential tool for NMOSD
diagnosis and beyond5,6

The path from initial presentation to diagnosis can take years7

Though often first encountered in the ER or by a PCP, correct diagnosis and ongoing care may involve multiple specialties8

A table illustrating the path from initial presentation of NMOSD symptoms which lead from encounters with healthcare practitioners at hospitals/ERs for severe attacks and encounters with PCPs, optometrists, and ophthalmologists for less severe symptoms to referrals to specialists including general neurologists, ophthalmologists, neuro-ophthalmologists, and neuroimmunologists for diagnosis

A table illustrating the path from initial presentation of NMOSD symptoms which lead from encounters with healthcare practitioners at hospitals/ERs for severe attacks and encounters with PCPs, optometrists, and ophthalmologists for less severe symptoms to referrals to specialists including general neurologists, ophthalmologists, neuro-ophthalmologists, and neuroimmunologists for diagnosis

A table illustrating the path from initial presentation of NMOSD symptoms which lead from encounters with healthcare practitioners at hospitals/ERs for severe attacks and encounters with PCPs, optometrists, and ophthalmologists for less severe symptoms to referrals to specialists including general neurologists, ophthalmologists, neuro-ophthalmologists, and neuroimmunologists for diagnosis

Time to first maintenance treatment can be up to 11 years for NMOSD patients icon

Time to first maintenance
treatment can be up to 11 years7

Expediting the referral process can lessen the time
between initial presentation and long-term treatment
while reducing NMOSD damage5,9,10

Discover how NMOSD-related
disability
accumulates over time Disability Accumulation

ER, emergency room; PCP, primary care provider.

  1. Mealy MA, Wingerchuk DM, Greenberg BM, Levy M. Epidemiology of neuromyelitis optica in the United States: a multicenter analysis. Arch Neurol. 2012;69(9):1176-1180.
  2. Sellner J, Boggild M, Clanet M, et al. EFNS guidelines on diagnosis and management of neuromyelitis optica. Eur Neurol. 2010;17:1019-1032.
  3. NORD rare disease database. Accessed November 21, 2022. https://rarediseases.org/rare-diseases/neuromyelitis-optica/
  4. Shosha E, Dubey D, Palace J, et al. Area postrema syndrome: frequency, criteria, and severity in AQP4-IgG–positive NMOSD. Neurology. 2018;19:e1642-e1651.
  5. Wingerchuk DM, Banwell B, Bennett JL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85:177-189.
  6. Xu Y, Ren Y, Li X, et al. Persistently gadolinium-enhancing lesion is a predictor of poor prognosis in NMOSD attack: a clinical trial. Neurotherapeutics. 2021;18:868-877.
  7. Beekman J, Keisler A, Pedraza O, et al. Neuromyelitis optica spectrum disorder: patient experience and quality of life. Neurol Neuroimmunol Neuroinflamm. 2019;6:1-14. doi:10.1212/NXI.0000000000000580
  8. Delgado-Garcia G, Lapidus S, Talero R, et al. The patient journey with NMOSD: from initial diagnosis to chronic condition. Front Neurol. 2022;13:1-10. doi:10.3389/fneur.2022.966428
  9. Borisow N, Mori M, Kuwabara S, Scheel M, Paul F. Diagnosis and treatment of NMO spectrum disorder and MOG-encephalomyelitis. Front Neurol. 2018;9:1-9. doi:10.3389/fneur.2018.00888
  10. Hamid SHM, Whittam D, Mutch K, et al. What proportion of AQP4-IgG-negative NMO spectrum disorder patients are MOG-IgG positive? A cross sectional study of 132 patients. J Neurol. 2017;264:2088-2094.