NMOSD – Refractory — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationNMOSD – RefractorySCE Neurology

A patient with AQP4-IgG-positive NMOSD has recovered from a second severe attack and is currently receiving no preventive treatment. Which long-term principle is most appropriate?

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Correct answer: B — Specialist relapse-prevention immunotherapy for NMOSD

The best answer is “Specialist relapse-prevention immunotherapy for NMOSD”. AQP4-NMOSD disability accumulates mainly through attacks, so effective maintenance immunotherapy should follow a confirmed relapsing diagnosis; selection among licensed biologic or conventional options depends on comorbidity, pregnancy and infection risk. “Observation until another disabling NMOSD attack occurs” is less appropriate because AQP4-positive disease has a substantial relapse risk and each event can leave major disability “Interferon-beta maintenance for aquaporin-4 autoimmunity” is less appropriate because MS-directed interferon beta is ineffective and may worsen NMOSD “Intermittent corticosteroid pulses during new symptoms” is less appropriate because reactive pulse treatment does not provide continuous relapse prevention “Rehabilitation without preventive immune treatment” is less appropriate because rehabilitation supports recovery but does not suppress pathogenic autoimmunity

Reference: NEMOS recommendations: attack therapy and long-term management of NMOSD. https://pmc.ncbi.nlm.nih.gov/articles/PMC10770020/