Neuromyelitis Optica Treatment in Malaysia

• Clinical assessment:
  • Neurological Evaluation: A detailed neurological examination assesses vision, eye movements, muscle strength, reflexes, sensation, coordination, gait and bladder or bowel function. The history focuses on the timing and pattern of attacks, previous neurological episodes, recovery between attacks and associated symptoms such as persistent vomiting or hiccups.
  • AQP4-IgG Antibody Testing: Serum AQP4-IgG testing is an important component of NMOSD evaluation. Cell-based assays are preferred when available because they offer improved sensitivity and specificity compared with some older tests.
  • MOG-IgG Testing: Consider MOG-IgG testing, particularly in AQP4-IgG-negative patients or when clinical and imaging features suggest MOG-associated disease.
  • Cerebrospinal Fluid Assessment: Lumbar puncture may be performed in selected patients to analyse cerebrospinal fluid and help distinguish NMOSD from infections, multiple sclerosis and other inflammatory or neurological disorders.
  • Visual and Neurophysiological Assessment: Visual acuity, colour vision, visual fields, optical coherence tomography and visual evoked potentials may help evaluate optic nerve involvement and establish a baseline for monitoring visual function.
• Imaging Tests:
  • MRI of the Brain: Helps identify lesions affecting the brainstem, area postrema, diencephalon and other characteristic regions and helps exclude alternative diagnoses.
  • MRI of the Spinal Cord: Particularly important for evaluating transverse myelitis. Longitudinally extensive spinal cord lesions involving multiple vertebral segments are characteristic of NMOSD, although shorter lesions can also occur.
  • MRI of the Optic Nerves: Helps identify optic neuritis, including lesions involving long segments of the optic nerve or optic chiasm.
  • Contrast-Enhanced MRI: May demonstrate active inflammation and help assess disease activity.
  • Optical Coherence Tomography: Provides a detailed assessment of the retinal nerve-fibre and ganglion-cell layers and may help monitor the structural effects of optic neuritis.

MediRehab (a chain of Rehab centres, part of MediGence) provides comprehensive tele-rehabilitation services designed to support Neuromyelitis Optica patients in Malaysia. These services include:

• Physiotherapy and Strength Training: Physiotherapy can help maintain muscle strength, flexibility, balance, and mobility after spinal cord injury or other neurological conditions.
• Gait and Mobility Rehabilitation: Patients with leg weakness, balance problems or spasticity may receive gait training, transfer training and appropriate assistive-device support.
• Vision Rehabilitation: Patients with persistent visual impairment may benefit from low-vision assessment, visual aids, environmental adaptations and training to improve independence.
• Bladder, Bowel and Functional Rehabilitation: Occupational and rehabilitation specialists can help patients manage bladder or bowel dysfunction, transfers, self-care and activities of daily living.
• Psychological and Long-Term Support: Counselling, patient education and fatigue-management strategies can help patients cope with a chronic neurological condition, recurrent attacks and changes in independence or daily functioning.

• Medicines for neuromyelitis optica spectrum disorder, NMOSD are used to control acute attacks and reduce the risk of future relapses. High-dose corticosteroids are commonly used during acute attacks, while plasma exchange may be added for severe attacks or inadequate steroid response. Long-term relapse prevention may involve conventional immunosuppressive medicines or targeted biological therapies for appropriate patients. These medicines require specialist monitoring for infections, laboratory abnormalities and other treatment-specific risks.