Friedemann Paul, MD, Charité – Universitätsmedizin Berlin, Berlin, Germany, discusses whether routine MRI surveillance is useful to assess disease activity in neuromyelitis optica spectrum disorder (NMOSD) and MOG antibody disease (MOGAD). Regular MRI follow-up is key to monitor disease activity and the efficacy of the therapeutic intervention in conditions like multiple sclerosis. However, it is unclear if this is transferable to NMOSD because disability appears predominantly related to attacks and it is unclear if silent inflammatory radiographic activity confers any risk for later deterioration of clinical status. This interview was conducted during the 2022 World Congress on Controversies in Neurology (CONy) meeting.