A team of researchers discovered that aquaporin-4 immunoglobulin G-positive (AQP4-IgG+) neuromyelitis optica spectrum disorder (NMOSD) relapses can result in disease progression and pain, according to a study published in the Journal of Neuroimmunology.

“Without effective treatment, nearly all (80%–90%) patients with [NMOSD] experience recurrent episodes of optic neuritis (ON), transverse myelitis (TM), or a mixed combination of ON and TM symptoms,” Kadish et al wrote.

In addition, neuropathic pain is also prominently reported in patients with NMOSD. Previous studies suggest that poor recovery from relapses can cause the gradual accumulation of visual and neurological disability. 

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The research team wanted to investigate this claim further by comparing patients with relapsing NMOSD with nonrelapsing patients. This would allow them to assess more accurately the clinical burden of relapses. They decided that a retrospective, observational cohort analysis was best suited for this purpose. 

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They analyzed NMOSD disease progression parameters in 47 patients with AQP4-IgG+ NMOSD enrolled at the University of Utah Health in Salt Lake City. The parameters measured were visual acuity, neurological disability, and pain medication. Among the 47 patients, 14 were patients with relapsing NMOSD and 33 were nonrelapsing patients. 

The results demonstrated that patients with AQP4-IgG+ NMOSD who experienced relapses had poorer outcomes. Among the relapsing cohort, researchers observed a 38% increase in the proportion of patients with visual impairment.

Patients from the relapsing cohort also reported clinically meaningful worsening of neurological disability, and the use of pain medication increased within 90 days of each relapse episode. 

“Therefore, treatment strategies with high efficacy in reducing the risk of relapses should be considered for patients with NMOSD,” the research team concluded.

“Future studies comparing different treatment options are warranted to determine which therapies are most effective at preventing relapses.” 


Kadish R, Clardy SL, Royston M, et al. Clinical burden of relapses in aquaporin-4 immunoglobulin G-positive neuromyelitis optica spectrum disorder: a single center cohort analysis. J Neuroimmunol. Published online November 2, 2021. doi:10.1016/j.jneuroim.2021.577761