Which diagnostic tests are essential for confirming a diagnosis of NMOSD in primary care?

Essential diagnostic tests for confirming neuromyelitis optica spectrum disorder (NMOSD) in primary care are not typically performed directly in this setting. Diagnosis should be made by an appropriate specialist, usually a consultant neurologist, based on established up-to-date criteria.

In primary care, the role is to recognise symptoms suggestive of NMOSD, such as episodes of optic neuritis or transverse myelitis, and refer promptly to a neurologist for further assessment and diagnostic testing.

The specialist will use a combination of clinical assessment and specific laboratory tests, including serum aquaporin-4 antibody testing, MRI of the brain and spinal cord, and cerebrospinal fluid analysis, to confirm the diagnosis.

Therefore, in primary care, the essential action is to identify clinical features suggestive of NMOSD and refer urgently to neurology rather than perform diagnostic tests directly.

This approach aligns with NICE recommendations that diagnosis of NMOSD should be made by a specialist using established criteria, and that isolated optic neuritis should prompt referral to a neurologist for further assessment.

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