Consensus Recommendations for the Diagnosis and Treatment of Neuromyelitis Optica Spectrum Disorders (NMOSD): The MENACTRIMS Guidelines
Journal: CNS Drugs; January 27, 2026
Author(s): Bassem Yamout, Riadh Gouider, Raed Al-Roughani, Salman Aljarallah, Nevine Shalaby, Jaber Al-Khabouri, Anu Jacob, Jihad Inshasi, Akram Mahdawi, Ahmed Shatila, Maya Zeineddine, Sarmad Al-Mashetah, Beatrice Canibano, Saeed Bohlega, Fatema Abdulla, Ilham Slassi, Aly Hassan, Sandra Ahmed, Magd Zakaria, Mohammed AlJumah, Yaser Al-Malik
How should NMOSD be diagnosed and treated in clinical practice? Guidelines for the Middle East and North Africa region
This paper provides expert recommendations, called the MENATRIMS Guidelines, on how NMOSD should be diagnosed and treated in real-world settings across the Middle East and North Africa (MENA region). The MENA region has unique challenges in healthcare delivery that are different from those in other regions, and therefore, the Middle East and North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS) set up an expert panel to develop these region-specific recommendations for how NMOSD should be diagnosed and managed, considering all the relevant global published research and best practices, as well as the practical realities of healthcare in the region.
NMOSD is a rare autoimmune disease that affects the brain, spinal cord, and optic nerves, and can sometimes be mistaken for multiple sclerosis. Testing for a specific antibody called aquaporin-4 (AQP4)-IgG has helped doctors diagnose NMOSD more accurately and choose more targeted treatments.
The paper emphasizes that early and accurate diagnosis with antibody testing is important, with clear attempts required to rule out similar conditions like multiple sclerosis, myelin oligodendrocyte glycoprotein-associated disease (MOGAD), and acute disseminated encephalomyelitis (ADEM).
New active episodes should be treated promptly with high-dose steroids via an intravenous drip and/or plasma exchange if attacks are severe and not responding to steroids.
For long-term treatment, the authors recommend starting immunosuppressive therapy early, with drugs such as rituximab, inebilizumab, eculizumab, ravulizumab, satralizumab, or tocilizumab, because recurrent NMOSD attacks can lead to lasting disability. The choice of treatment is based on factors such as availability, patient characteristics, and safety. In settings where newer treatments are not available, older immunosuppressive drugs may still be used as alternatives.
The paper also highlights special situations, such as pregnancy and childhood NMOSD, where treatment decisions may need to be adjusted. For example, planning pregnancy after a period of disease stability and restarting treatment soon after delivery may help reduce the risk of relapse.
Overall, the paper suggests that better outcomes in NMOSD depend on timely diagnosis, appropriate long-term treatment, and careful management of individual patient needs.
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