An AQP4-IgG antibody test is recommended for diagnosing NMOSD1,2

Conducting proper antibody testing and a full diagnostic workup is the key to confirming Neuromyelitis Optica Spectrum Disorder (NMOSD) and distinguishing it from other autoimmune diseases.1,2

Crack

DIAGNOSTIC CRITERIA

DIAGNOSTIC CRITERIA FOR PATIENTS WITH AQP4-IgG+ NMOSD1

At least 1 core clinical characteristic:

  • Optic neuritis
  • Acute myelitis
  • Area postrema syndrome
  • Acute brain stem syndrome
  • Symptomatic narcolepsy or acute diencephalic clinical syndrome with NMOSD-typical diencephalic MRI lesions
  • Symptomatic cerebral syndrome with NMOSD-typical brain lesions

Positive test for aquaporin-4 immunoglobulin G (AQP4-IgG) antibodies

Exclusion of alternative diagnoses such as multiple sclerosis (MS), sarcoidosis, or neoplasm

FURTHER STUDIES CAN HELP DETERMINE A DIAGNOSIS OF NMOSD

Medical history and physical exam2

Perform detailed medical history

Pay special attention to:

  • Brain stem symptoms
  • Neuropathic pain
  • Painful tonic spasms

Laboratory tests1,2

Blood work

  • Rule out infection and connective disorders

Cerebrospinal fluid (CSF) diagnostics

  • Unlike in MS, most CSF alterations in NMOSD present during acute events and disappear during remission

Serum AQP4-IgG testing

  • Essential and most important test in the diagnosis of NMOSD
  • Confirm with methodologically independent assay

Electrophysiology analysis2

Visual evoked potentials

Median and tibial somatosensory evoked potentials

Motor evoked potentials

Imaging studies2

MRI

  • Image entire CNS
  • Central longitudinal spinal cord lesions are typical of NMOSD

Optical coherence tomography

  • Useful for imaging unmyelinated CNS axons within the retina

SERUM TESTING

A POSITIVE SERUM ANTIBODY TEST IS CRUCIAL FOR DIAGNOSING AQP4-IgG+ NMOSD1,2

The likelihood of having a false-negative result with ELISA methodology is between 1.5 and 15 times greater when compared to the cell-based assay.5

CELL-BASED ASSAY IS THE PREFERRED METHOD OF TESTING1

FACS Live Cell-Based Assay3 ELISA3,4
Starting material Cell-based Cell-free
Detection Fluorescence or flow cytometry Colorimetric
Sensitivity >80% 60%-65%
Specificity >99% 99%

Abbreviations: ELISA, enzyme-linked immunosorbent assay; FACS, fluorescence-activated cell sorting.

The likelihood of having a false-negative result with ELISA methodology is between 1.5 and 15 times greater when compared to the cell-based assay.5

FALSE NEGATIVES CAN HAPPEN;
IF SIGNS POINT TO NMOSD, A RETEST IS RECOMMENDED1

A FALSE NEGATIVE IS MORE LIKELY TO HAPPEN IF5:

If clinical suspicion remains, you may retest 3 to 6 months after a negative result.5

A patient is recovering from relapse

A patient is currently on immunosuppressive therapies

A less accurate method of testing was used

 

If clinical suspicion remains, you may retest 3 to 6 months after a negative result.5

References: 1. Wingerchuk DM, Banwell B, Bennett JL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85(2):177-189. 2. Trebst C, Jarius S, Berthele A, et al. Update on the diagnosis and treatment of neuromyelitis optica: recommendations of the Neuromyelitis Optica Study Group (NEMOS). J Neurol. 2014;261(1):1-16. 3. Test ID: NMOFS. Mayo Clinic Laboratories website. https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/38324. Accessed April 9, 2019. 4. Waters PJ, McKeon A, Leite MI, et al. Serologic diagnosis of NMO: a multicenter comparison of aquaporin-4-IgG assays. Neurology. 2012;78(9):665-671. 5. Waters PJ, Pittock SJ, Bennett JL, Jarius S, Weinshenker BG, Wingerchuk DM. Evaluation of aquaporin-4 antibody assays. Clin Exp Neuroimmunol. 2014;5(3):290-303.

IN NMOSD, EVERY ATTACK MATTERS

Sign up for additional information on Neuromyelitis Optica Spectrum Disorder (NMOSD) and to receive future updates on NMOSD.

This is a required field.
This is a required field.
This is a required field.
This is a required field.
This is a required field.

By providing my information above, I am giving Alexion and companies working with Alexion permission to contact me by mail, email, telephone, or text message for communications or marketing purposes to provide me with information about Alexion’s products, services, and programs or other topics of interest; conduct market research; or ask me about my experience with or thoughts about such topics. Alexion will not sell or transfer my information to any unrelated third party for marketing purposes without my express permission. Please see Privacy Notice.

Thank you for submitting your information

There was an error processing your request.