Pre-test

The New Era of Neuromyelitis Optica Spectrum Disorder: Advances in Diagnosis and Treatment

For each question, please select the best option then click the button at the end of the test to proceed.

Items marked with * require a response.

Which of the following clinical features is more characteristic of aquaporin-4 (AQP4) IgG seropositive NMOSD than of multiple sclerosis (MS)?*

A relapsing course
A progressive course, unrelated to attacks
Unilateral optic neuritis
Complete transverse myelitis

According to the 2015 International Panel for NMO Diagnosis (IPND) criteria, which of the following features is/are required and sufficient for diagnosis of NMOSD in a patient with optic neuritis, assuming alternative diagnoses have been excluded?*

AQP4 antibody positivity
AQP4 antibody positivity plus involvement of the optic chiasm on MRI
AQP4 antibody positivity plus a history of a previous attack of acute myelitis
A history of acute myelitis, regardless of AQP4 antibody status

Which of the following statements about testing for AQP4 antibodies is correct?*

Testing both serum and cerebrospinal fluid (CSF) is recommended to increase sensitivity
Cell-based serum assays are the most sensitive and specific detection method
Testing during remission is recommended to avoid false-positive results
The presence of other autoimmune disorders may lead to false-negative results

A patient with systemic lupus erythematosus (SLE) presents to the emergency department with acute transverse myelitis. While on the phone with the patient’s rheumatologist arranging for hospital admission, the emergency medicine clinician asks if the patient should be tested for AQP4 antibodies. Assuming the patient is not being treated with a B-cell depleting therapy, which of the following responses would be most appropriate?*

Yes, but only if the serum sample can be obtained prior to administration of corticosteroids
Yes, but don’t delay treatment with corticosteroids while awaiting the results
No because the myelitis is most likely a complication of SLE
No because the test is likely to produce a false-positive result due to SLE autoantibodies

Which of the following therapies for NMOSD depletes B cells by targeting CD19?*

Eculizumab
Inebilizumab
Rituximab
Satralizumab

A patient with NMOSD experiences a relapse approximately 4 months after her last infusion of rituximab. Lab results, including a CBC with differential and liver function tests, are normal. Which of the following findings would best support a decision to switch to a different preventive therapy?*

Seroconversion to AQP4 antibody-negative status
A positive test for myelin oligodendrocyte glycoprotein (MOG) antibodies
CD19+ cell count is <1% of total lymphocytes
CD19+ cell count is ≥1% of total lymphocytes