Application and interpretation of core elements of the 2015 NMOSD diagnostic criteria in routine clinical practice
BackgroundWe evaluated comprehension and application of the 2015 neuromyelitis optica spectrum disorder (NMOSD) criteria core elements by neurologists in Latin America (LATAM) who routinely diagnose and care for NMOSD patients by (i) identifying typical/suggestive NMOSD syndromes, (ii) detecting typ...
Saved in:
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2024-12-01
|
| Series: | Frontiers in Immunology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1515481/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846126165973008384 |
|---|---|
| author | Edgar Carnero Contentti Edgar Carnero Contentti Juan I. Rojas Ricardo Alonso Michael R. Yeaman Michael R. Yeaman Brian G. Weinshenker |
| author_facet | Edgar Carnero Contentti Edgar Carnero Contentti Juan I. Rojas Ricardo Alonso Michael R. Yeaman Michael R. Yeaman Brian G. Weinshenker |
| author_sort | Edgar Carnero Contentti |
| collection | DOAJ |
| description | BackgroundWe evaluated comprehension and application of the 2015 neuromyelitis optica spectrum disorder (NMOSD) criteria core elements by neurologists in Latin America (LATAM) who routinely diagnose and care for NMOSD patients by (i) identifying typical/suggestive NMOSD syndromes, (ii) detecting typical MRI NMOSD lesions and meeting MRI dissemination in space (DIS) criteria, and (iii) evaluating historical symptoms suggestive of NMOSD.MethodsWe conducted an anonymous, voluntary, self-administered web- and case-based survey cross-sectional study from October 2023 to January 2024 of neurologists identified through the LACTRIMS database. Questions were presented first through iterative clinical cases or imaging, followed by questions directly evaluating comprehension of definitions. “Correct” responses were based on the 2015 criteria and adjudicated by the consensus of the experts leading the project.ResultsA total of 106 neurologists (60.3% female; mean age: 46.6 ± 12.5 years) were included. Between 10.4% and 49.1% of neurologists inaccurately identified clinical or paraclinical aspects for DIS and 32.1% accurately identified the three non-cardinal (brainstem, diencephalic, and cerebral) syndromes for seronegative patients. Between 35.8% and 64.1% of neurologists identified the “optimal timing” of AQP4-IgG testing (e.g., during an attack or before receiving immunosuppressant treatments, among others); 56.6% considered live cell-based assay as the gold standard method for serological testing. Most neurologists accurately identified typical NMOSD MRI lesions, but periventricular, juxtacortical/cortical, fluffy infratentorial, corticospinal tract, and hypothalamic lesions were frequently misidentified.ConclusionClinical scenarios were identified where the 2015 NMOSD criteria were susceptible to misinterpretation and misapplication by expert neurologists in LATAM. Implementing collaborative educational initiatives could improve NMOSD diagnosis and raise patient care standards. |
| format | Article |
| id | doaj-art-d7ab6d6c3a3247d3b5b3dfa46e76a2bc |
| institution | Kabale University |
| issn | 1664-3224 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Immunology |
| spelling | doaj-art-d7ab6d6c3a3247d3b5b3dfa46e76a2bc2024-12-13T05:10:22ZengFrontiers Media S.A.Frontiers in Immunology1664-32242024-12-011510.3389/fimmu.2024.15154811515481Application and interpretation of core elements of the 2015 NMOSD diagnostic criteria in routine clinical practiceEdgar Carnero Contentti0Edgar Carnero Contentti1Juan I. Rojas2Ricardo Alonso3Michael R. Yeaman4Michael R. Yeaman5Brian G. Weinshenker6Neuroimmunology Unit, Department of Neurosciences, Hospital Aleman, Buenos Aires, ArgentinaCentro de Enfermedades Neuroinmunológicas de Rosario (CENRos), Neuroimmunology Clinic, Instituto de Neurologia Cognitiva (INECO) Neurociencias Oroño, Rosario, ArgentinaDepartment of Neurology, Hospital Universitario Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, ArgentinaDepartment of Neurology, Hospital Ramos Mejia, Buenos Aires, ArgentinaDepartment of Medicine, Divisions of Molecular Medicine and Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United StatesDepartment of Medicine Lundquist Institute for Biomedical Innovation at Harbor-University of California Los Angeles Medical Center, Los Angeles, CA, United StatesDepartment of Neurology, University of Virginia, Charlottesville, VA, United StatesBackgroundWe evaluated comprehension and application of the 2015 neuromyelitis optica spectrum disorder (NMOSD) criteria core elements by neurologists in Latin America (LATAM) who routinely diagnose and care for NMOSD patients by (i) identifying typical/suggestive NMOSD syndromes, (ii) detecting typical MRI NMOSD lesions and meeting MRI dissemination in space (DIS) criteria, and (iii) evaluating historical symptoms suggestive of NMOSD.MethodsWe conducted an anonymous, voluntary, self-administered web- and case-based survey cross-sectional study from October 2023 to January 2024 of neurologists identified through the LACTRIMS database. Questions were presented first through iterative clinical cases or imaging, followed by questions directly evaluating comprehension of definitions. “Correct” responses were based on the 2015 criteria and adjudicated by the consensus of the experts leading the project.ResultsA total of 106 neurologists (60.3% female; mean age: 46.6 ± 12.5 years) were included. Between 10.4% and 49.1% of neurologists inaccurately identified clinical or paraclinical aspects for DIS and 32.1% accurately identified the three non-cardinal (brainstem, diencephalic, and cerebral) syndromes for seronegative patients. Between 35.8% and 64.1% of neurologists identified the “optimal timing” of AQP4-IgG testing (e.g., during an attack or before receiving immunosuppressant treatments, among others); 56.6% considered live cell-based assay as the gold standard method for serological testing. Most neurologists accurately identified typical NMOSD MRI lesions, but periventricular, juxtacortical/cortical, fluffy infratentorial, corticospinal tract, and hypothalamic lesions were frequently misidentified.ConclusionClinical scenarios were identified where the 2015 NMOSD criteria were susceptible to misinterpretation and misapplication by expert neurologists in LATAM. Implementing collaborative educational initiatives could improve NMOSD diagnosis and raise patient care standards.https://www.frontiersin.org/articles/10.3389/fimmu.2024.1515481/fullneuromyelitis optica spectrum disorderdiagnosismisdiagnosiscriteriaMRI |
| spellingShingle | Edgar Carnero Contentti Edgar Carnero Contentti Juan I. Rojas Ricardo Alonso Michael R. Yeaman Michael R. Yeaman Brian G. Weinshenker Application and interpretation of core elements of the 2015 NMOSD diagnostic criteria in routine clinical practice Frontiers in Immunology neuromyelitis optica spectrum disorder diagnosis misdiagnosis criteria MRI |
| title | Application and interpretation of core elements of the 2015 NMOSD diagnostic criteria in routine clinical practice |
| title_full | Application and interpretation of core elements of the 2015 NMOSD diagnostic criteria in routine clinical practice |
| title_fullStr | Application and interpretation of core elements of the 2015 NMOSD diagnostic criteria in routine clinical practice |
| title_full_unstemmed | Application and interpretation of core elements of the 2015 NMOSD diagnostic criteria in routine clinical practice |
| title_short | Application and interpretation of core elements of the 2015 NMOSD diagnostic criteria in routine clinical practice |
| title_sort | application and interpretation of core elements of the 2015 nmosd diagnostic criteria in routine clinical practice |
| topic | neuromyelitis optica spectrum disorder diagnosis misdiagnosis criteria MRI |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2024.1515481/full |
| work_keys_str_mv | AT edgarcarnerocontentti applicationandinterpretationofcoreelementsofthe2015nmosddiagnosticcriteriainroutineclinicalpractice AT edgarcarnerocontentti applicationandinterpretationofcoreelementsofthe2015nmosddiagnosticcriteriainroutineclinicalpractice AT juanirojas applicationandinterpretationofcoreelementsofthe2015nmosddiagnosticcriteriainroutineclinicalpractice AT ricardoalonso applicationandinterpretationofcoreelementsofthe2015nmosddiagnosticcriteriainroutineclinicalpractice AT michaelryeaman applicationandinterpretationofcoreelementsofthe2015nmosddiagnosticcriteriainroutineclinicalpractice AT michaelryeaman applicationandinterpretationofcoreelementsofthe2015nmosddiagnosticcriteriainroutineclinicalpractice AT briangweinshenker applicationandinterpretationofcoreelementsofthe2015nmosddiagnosticcriteriainroutineclinicalpractice |