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Giant Cell Arteritis — SCE Neurology MCQ

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HardNeuro-ophthalmologyGiant Cell ArteritisSCE Neurology

A patient with aquaporin-4-IgG-positive NMOSD has recovered from a first severe longitudinally extensive myelitis attack. MRI brain does not meet multiple-sclerosis criteria. What is the best long-term principle?

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Correct answer: E — Start long-term relapse-prevention immunotherapy after specialist counselling

AQP4-positive NMOSD is highly relapse prone and attacks commonly leave major disability, so long-term preventive immunotherapy is generally started after the first attack. Waiting for recurrence is unsafe. MS platform drugs such as interferon beta or glatiramer are ineffective and can worsen disease; intermittent steroid pulses are not an adequate sole maintenance strategy.

Reference: NEMOS 2023 recommendations for NMOSD attack therapy and long-term management (Published 2023): https://pmc.ncbi.nlm.nih.gov/articles/PMC10770020/