ECTRIMS 2021 | Recent evidence for subclinical disease activity in NMOSD

Bruce Cree, MD, PhD, MAS, University of California San Francisco, San Francisco, CA, discusses new evidence suggesting the presence of subclinical disease activity and progressive disease in neuromyelitis optica spectrum disorder (NMOSD). A recent neuroimaging study assessed changes in the optic nerves, brain, brain stem and spinal cord at baseline, at the time of clinical attach, and at fixed intervals over the course of the trial. It was demonstrated that attacks were not limited to the area of clinical event.
Myelitis attacks were associated with lesions in the optic nerves and equally, optic neuritis attacks were associated with subclinical attacks of myelitis, as evidenced by gadolinium enhancement of the spinal cord. This might indicate that there is subclinical disease activity in NMO that can involve the optic nerve and spinal cord. Furthermore, studies have shown that disability worsening in patients with NMOSD can be related to or independent from clinical attacks. In combination with novel serum biomarkers indicating tissue injury, these discoveries could enable us to better understand the mechanisms of NMOSD disease pathogenesis and disability worsening. This interview took place at the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) congress 2021.