White matter disconnections in the brain and spinal cord are associated with the severity of disability in patients with neuromyelitis optica spectrum disorder (NMOSD), according to a new study published in the journal Brain Imaging and Behavior. Disconnections in specific areas can predict the severity of the disability, the authors also said.

Even though research has increasingly shown that brain lesions show a distinct pattern characteristic of NMOSD, the association between these lesions and the clinical course of the disease is still not clear. 

Read more about the prognosis of NMOSD

Continue Reading

To find the possible link between neurological impairment and brain lesions in NMOSD, a team of researchers from Korea assessed structural disconnections in the brains of 20 patients.

The study team drew, by hand, white matter lesions in the brains of these patients, section by section. They then estimated whole-brain structural disconnection and the Expanded Disability Status Scale (EDSS) scores using connectome-based predictive modeling.

They found that connectome-based predictive modeling was able to predict EDSS scores successfully. 

More precisely, most edges important for the prediction process connected the motor network to the frontoparietal network. They also found disconnections in the periependymal white matter tracts correlated with EDSS scores.

“We suggest white matter disconnection that has a predilection for periependymal areas and disconnects motor and frontoparietal areas, thus resulting in high EDSS scores in NMOSD patients,” the authors wrote.

“Although more evidence is needed, we propose that a network-focused conceptual framework of NMOSD could further our understanding of its pathophysiology and future impact on clinical decision-making and the design of network-tailored rehabilitation strategies,” they added.

NMOSD is a chronic demyelinating central nervous system disease characterized by recurrent attacks mainly affecting the optic nerve, spinal cord, and area postrema. The disease is primarily caused by the production of autoantibodies against the astrocytic water channel, aquaporin-4.


Kim M, Choi KS, Hyun RC, et al. Structural disconnection is associated with disability in the neuromyelitis optica spectrum disorder. Brain Imaging Behav. Published online September 7, 2023. doi:10.1007/s11682-023-00792-4