COVID-19 and Neuromyelitis Optica Disorder: A Need for Guidance-Based Management

Little guidance has been issued on how to manage patients with COVID-19 and coexisting neurological disorders.

As the novel coronavirus disease 2019 (COVID-19) pandemic continues to unfold and healthcare workers scramble to meet demands of affected patients, little guidance has been issued on how to manage patients with COVID-19 and coexisting neurological disorders.

In a recent paper in Multiple Sclerosis and Related Disorders, neuroscience and infectious disease experts from the University of Buenos Aires suggest neuromyelitis optica spectrum disorder (NMOSD), and the immunosuppressant therapies used to treat it, may present an additional challenge in the management of patients with COVID-19.

There is currently no evidence that NMOSD, a chronic brain and spinal cord disorder characterized by inflammation of the optic nerve and spinal cord, increases the risk of COVID-19 infection. In addition, no evidence exists to link COVID-19 to an increased risk of NMOSD relapse, despite that infections can trigger relapses in some patients. Regardless, long-term relapse prevention therapy for aquaporin-4 (AQP4-ab)-positive and -negative patients with NMOSD is still recommended. Monoclonal antibodies, including eculizumab, inebilizumab, rituximab, and satralizumab, may support prevention.

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In their paper, the authors from the University of Buenos Aires wrote that there is also no evidence to suggest clinicians halt immunosuppressant treatment in patients with NMOSD who have been infected by COVID-19. Also, no consensus statement has been issued on the management of patients with NMOSD and COVID-19 who are treated with immunosuppressant therapy. This lack of guidance indicates the need for more rigorous observational study in these patients to determine an appropriate management strategy.

The authors wrote that additional information gleaned from this research “will be crucial for patients and clinicians to make evidence-based decisions on how we should manage their disease during the pandemic, or in case of acquiring COVID-19.”


Carnero Contentti E, Correa J. Immunosuppression during the COVID-19 pandemic in neuromyelitis optica spectrum disorders patients: a new challenge. Mult Scler Relat Disord. doi: 10.1016/j.msard.2020.102097.