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

Conducting AQP4-IgG 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

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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) auto-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

(CSF) diagnostics

Test for serum AQP4-lgG antibodies

  • Essential and most important test in the diagnosis of NMOSD
  • Rules out other infections/diseases

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

LIVE CELL-BASED ASSAY IS THE PREFERRED METHOD OF TESTING1,5 ELISA testing could miss some of your most severe patients. ELISA testing is showing to have a higher likelihood of false negative results compared to the live cell-based assay.

CELL-BASED ASSAY IS THE PREFERRED METHOD OF TESTING1

Live Cell-Based Assay4 ELISA3,4 Fixed Cell-Based Assay3
Starting material Cell-based Cell-free Cell-based
Detection Fluorescence or flow cytometry Colorimetric Fluorescence
Sensitivity >90% 60%-65% 75%
Specificity >99% 99% >99%

Abbreviations: ELISA, enzyme-linked immunosorbent assay

LIVE CELL-BASED ASSAY IS THE PREFERRED METHOD OF TESTING1,5 ELISA testing could miss some of your most severe patients. ELISA testing is showing to have a higher likelihood of false negative results compared to the live cell-based assay.

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 an attack

A patient is currently on immunosuppressive therapies

A less sensitive 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. Euroimmun product sheet https://www.euroimmun.com/documents/Indications/Autoimmunity/Neurology/Neuromyelitis-optica/FA_1128_D_UK_A.pdf Sensitivity will vary from lab to lab. 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.

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