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CC BY 4.0 · Arq Neuropsiquiatr 2025; 83(02): s00451801845
DOI: 10.1055/s-0045-1801845
Review Article

A roadmap to increasing access to AQP4-Ig testing for NMOSD: expert recommendations

Raquel Vassão-Araujo 
1   Santa Casa de Belo Horizonte (CAPPEM), Departamento de Neurologia, Belo Horizonte MG, Brazil.
2   Crônicos do Dia a Dia, Inovação Científica e Pesquisa, Guarulhos SP, Brazil.
,
Samira Apóstolos 
3   Universidade de São Paulo, Departamento de Neurologia, São Paulo SP, Brazil.
,
Angela Marie Jansen 
4   Americas Health Foundation, Washington DC, United States.
,
Marco A. Lana-Peixoto 
5   Universidade Federal de Minas Gerais, Faculdade de Medicina, Centro de Pesquisas CIEM MS, Belo Horizonte MG, Brazil.
,
Antonio Pereira Gomes Neto 
1   Santa Casa de Belo Horizonte (CAPPEM), Departamento de Neurologia, Belo Horizonte MG, Brazil.
,
Mariana Rico-Restrepo 
6   Americas Health Foundation, Bogota, Colombia.
,
Soniza Vieira Alves-Leon 
7   Universidade Federal do Estado do Rio de Janeiro, Departamento de eurologia, Rio de Janeiro RJ, Brazil.
8   Universidade Federal do Rio de janeiro, Hospital Universitário Clementino Fraga Filho, Centro Pesquisa e Inovação, Rio de Janeiro RJ, Brazil.
,
Douglas Kazutoshi Sato 
9   Pontifícia Universidade Católica do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre RS, Brazil.
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Abstract

The discovery of aquaporin 4 immunoglobulin G (AQP4-IgG) autoantibody, present in ∼80% of patients with neuromyelitis optica spectrum disorder (NMOSD), dramatically improved its diagnosis, treatment, and prognosis. While Brazil has a higher prevalence of NMOSD (up to 4.5 per 100,000 people) compared with global averages, disparities in access to testing in Brazil impede early diagnosis and treatment. To tackle these issues, the Americas Health Foundation convened a three-day virtual conference with six Brazilian NMOSD experts. This paper emphasizes the importance of addressing the gaps in physicians' knowledge about NMOSD. Stakeholders, including government agencies, should develop national programs for continuing medical education. The public healthcare system should ensure the availability and accessibility of AQP4-IgG antibody testing. Clinical practice guidelines for NMOSD diagnosis and treatment must be established. Such guidelines will enable healthcare providers to manage patients promptly after the initial attack, reducing relapses and improving quality of life. Finally, addressing the fragmented healthcare system, including bridging the gap between public and private institutions and improving access to telemedicine, will aid individuals in Brazil with NMOSD in receiving early diagnosis and treatment. NMOSD presents unique challenges in Brazil because of its higher prevalence and limited access to crucial AQP4-IgG tests. Overcoming these challenges requires collaboration among experts, healthcare providers, government agencies, and the public healthcare system to improve diagnosis, treatment, and patient outcomes.

Keywords

Aquaporin 4 - Autoantibodies Diagnostic Techniques and Procedures - Healthcare Disparities - Neuromyelitis Optica

Authors' Contributions

RVA, SA, MALP, APGN, SVAL, DKS: writing-original draft, investigation, formal analysis, validation; AMJ: writing-review and editing, methodology, project administration; MRR: writing-review, editing, visualization, conceptualization, methodology, project administration.


Support

The organization and implementation of the conference were performed by the Americas Health Foundation, a 501(c)(3) nonprofit organization dedicated to improving healthcare throughout Latin America, supported by an unrestricted grant from Horizon Therapeutics. The funder did not influence this manuscript's design, implementation, or content.


Editor-in-Chief: Hélio A. G. Teive.


Associate Editor: Maria Fernanda Mendes.




Publication History

Received: 28 June 2024

Accepted: 04 October 2024

Article published online:
19 March 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Raquel Vassão-Araujo, Samira Apóstolos, Angela Marie Jansen, Marco A. Lana-Peixoto, Antonio Pereira Gomes Neto, Mariana Rico-Restrepo, Soniza Vieira Alves-Leon, Douglas Kazutoshi Sato. A roadmap to increasing access to AQP4-Ig testing for NMOSD: expert recommendations. Arq Neuropsiquiatr 2025; 83: s00451801845.
DOI: 10.1055/s-0045-1801845
 

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