Neuromyelitis Optica Spectrum Disorders and Acute Transverse Myelitis

Neuromyelitis optica spectrum disorders (NMOSD) and acute transverse myelitis (ATM) are distinct yet overlapping immune-mediated myelopathies characterised by spinal cord inflammation. NMOSD is marked by relapsing attacks of optic neuritis and longitudinally extensive spinal cord lesions, often driven by aquaporin-4 antibodies that target astrocytic water channels. In contrast, ATM presents as a monophasic or relapsing injury confined to the spinal cord, with motor, sensory and autonomic dysfunction arising over hours to days. Both conditions share clinical features such as limb weakness, sensory alterations and sphincter disturbances, but differ in immunopathogenesis, imaging signatures and risks of relapse. Magnetic resonance imaging remains the cornerstone of diagnosis, revealing lesion length, axial distribution and enhancement patterns that guide differentiation. Therapies for NMOSD focus on antibody depletion and complement inhibition to prevent recurrence, whereas management of ATM emphasises high-dose corticosteroids and plasma exchange to limit acute damage, with immunosuppressive maintenance for those who relapse. Advances in serological assays, MRI techniques and cellular biomarkers have refined diagnostic algorithms and enabled earlier intervention. Globally, these disorders impose substantial morbidity and healthcare costs, spurring research into personalised treatment strategies and neuroprotective approaches aimed at improving long-term neurological outcomes.

Research from Nature Portfolio

Recent studies have delineated clinical and imaging criteria that distinguish NMOSD from other causes of non-compressive myelopathy. Analyses of spinal MRI patterns demonstrated that patients with NMOSD typically exhibit long segment lesions with central localisation, bright spotty lesions and higher cord expansion ratios, in contrast to shorter, peripheral infarction patterns seen in vascular injury. Demographic comparisons confirmed a younger, predominantly female NMOSD cohort with subacute progression, while spinal cord infarction was associated with older age and abrupt onset. The development of an imaging-based diagnostic score, integrating lesion length, axial distribution and characteristic signal abnormalities, has improved specificity and sensitivity, enabling more rapid initiation of targeted immunotherapy and reducing diagnostic uncertainty in acute presentations.

Neuromyelitis Optica Spectrum Disorders and Acute Transverse Myelitis publication trend

The graph below shows the total number of articles in neuromyelitis optica spectrum disorders and acute transverse myelitis across all publications each year (not limited to Nature Index journals).

Technical terms

Neuromyelitis optica spectrum disorders: A group of antibody-mediated diseases targeting astrocytes, causing recurrent optic neuritis and spinal cord inflammation.

Acute transverse myelitis: Rapid onset inflammation of the spinal cord, presenting with bilateral motor, sensory and autonomic deficits over hours to days.

Aquaporin-4 antibody: Autoantibody directed against the water channel aquaporin-4, highly specific for NMOSD and pathogenic in astrocyte injury.

Longitudinally extensive transverse myelitis: A spinal cord lesion extending over three or more vertebral segments, characteristic of NMOSD.

Plasmablast: An early antibody-secreting B-cell subset implicated in the production of autoreactive immunoglobulins in demyelinating disorders.

References

1. Astrocytic stress response is induced by exposure to astrocyte-binding antibodies expressed by plasmablasts from pediatric patients with acute transverse myelitis. Journal of Neuroinflammation (2024).
2. Discontinuation of Immunotherapy in Patients With Relapsing Myelitis Without AQP4/MOG Antibodies. Annals of Clinical and Translational Neurology (2025).
3. Myelitis features and outcomes in CNS demyelinating disorders: Comparison between multiple sclerosis, MOGAD, and AQP4-IgG-positive NMOSD. Frontiers in Neurology (2022).
4. A comparison between spinal cord infarction and neuromyelitis optica spectrum disorders: Clinical and MRI studies. Scientific Reports (2019).