Expert Panel Publishes Revised Consensus Recommendations for Diagnosis and Management of NMOSD

November 2025

Key Takeaways

• Updated recommendations emphasize individualized care, antibody testing, and long-term immunosuppressive strategies for NMOSD management.
• The panel reviewed 56 studies, resulting in 27 recommendations and 90 statements on diagnostic and treatment strategies.

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In a newly published study, researchers developed expert-driven, evidence-based, up-to-date consensus recommendations for managing neuromyelitis optica spectrum disorder in Saudi Arabia.

Salman Aljarallah, MBBS

(Credit: Doctor’s Magazine)

A multidisciplinary panel of experts has published a revised set of evidence-based recommendations for the diagnosis and management of neuromyelitis optica spectrum disorder (NMOSD) in Saudi Arabia, incorporating recent therapeutic developments and emerging biomarker insights since the 2022 consensus publication.^1,2 The updated guidance emphasized individualized care, antibody testing, long-term immunosuppressive strategies, and underscored the need for further research on treatment duration as well as failure criteria.

A group of neurologists, neuroimmunologists, epidemiologists, and pharmacists convened under the Saudi Neurology Society Multiple Sclerosis Chapter reviewed 56 studies through a GRADE assessment. From the initial 128 statements and 25 recommendations developed under various themes for voting, the process resulted in a final set of 27 recommendations and 90 statements. The finalized recommendations addressed key areas, including diagnostic strategies, diagnostic criteria, and acute and chronic treatments in NMOSD, as well as recommendations regarding the diagnosis and treatment of myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD).

“Over the past decade, neurologists—both locally and internationally—have become much more familiar with recognizing NMOSD and proactively testing for AQP4 antibodies. What these recommendations add is a stronger emphasis on using the correct testing methodology, especially in settings where access to live cell–based assays is limited,” lead author Salman Aljarallah, MBBS, FRCPC, assistant professor of medicine at King Saud University in Saudi Arabia, told NeurologyLive^® in a recent interview.

“For MOGAD, the guideline highlights the need to be cautious with false positives, particularly when the antibody titers are low. This is something that continues to challenge us in daily practice, and the recommendations reinforce the importance of interpreting those results in the right clinical context,” Aljarallah said. “The most important change in this guideline is the emphasis on starting biologic therapy as the first line and also supporting the earlier use of complement inhibitors when the concern of a potential severe outcome from a relapse.”

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