When should I consider referring a patient with suspected NMOSD to a specialist for further evaluation?

Consider referring a patient with suspected neuromyelitis optica spectrum disorder (NMOSD) to a specialist for further evaluation when:

• They present with clinical features suggestive of NMOSD, such as episodes of optic neuritis or transverse myelitis.
• Diagnosis requires confirmation by an appropriate specialist using established up-to-date criteria, as NMOSD diagnosis is complex and specialist-led.
• There is a need to exclude alternative diagnoses and to perform specialized investigations, including antibody testing and MRI, which are beyond primary care scope.
• Referral should be made to a consultant neurologist or a specialist under their supervision for diagnosis and management.

Specifically, if a patient has an episode of isolated optic neuritis confirmed by an ophthalmologist, they should be referred to a consultant neurologist for further assessment, as this may be part of NMOSD presentation.

Overall, any suspicion of NMOSD warrants prompt referral to a neurology specialist for accurate diagnosis and initiation of appropriate treatment.

NICE NG220