The role of multidisciplinary management in NMOSD

Michael Yaman, Ph.D.: Another way to think about a diagnosis might be to think of the hierarchical team of health care providers involved in diagnosing and treating patients. Merla, in your experience, when a patient presents you with a high suspicion index of NMOSD [neuromyelitis optica spectrum disorder]give us an idea of ​​the chain of healthcare providers that are involved in helping you diagnose and treat disease.

Merla Avila, MD: surely. It depends on the path the patient is on. I have a very good relationship with our ophthalmology group. If they suspect this, they text me and I will bring the patient to my clinic right away, and I will see the patient myself. But with patients who come from ED [emergency department]I usually ask the on-call team to see them, so residents and medical students see them first. who attended [physician] It is this week we will see them. If they suspect NMOSD and I am not present, they will contact me and share. It will take a little longer. It depends on whether they come through ED or directly from neuro-ophthalmology.

If they’re coming from a primary care doctor, it’s going to take longer because sometimes they don’t even imagine or suspect it. I remember a case of optic neuritis where they didn’t do the MRI because the symptoms started improving after about two or three weeks. Then when she had another optic neuritis, he caught their attention and referred her to a general neurologist, then a general neurologist. [referred the patient] For myself. That took a little longer.

Michael Yaman, Ph.D.: [That shows] The importance of having a specialist who knows NMOSD coordinate the process. Mitzi, maybe you can share with us your experience of how and when to get involved in neuroradiology to help with diagnosis.

Mitzi Williams, MD: This is an excellent question. I am very fortunate that most of the studies I order are read by my neuroradiologist, and I also look at all the MRI images of all my patients. I’m not a neuroradiologist, but I look at all the studies with the patient so we can make sure we’re on the same page and they see the same thing I do. If there is any question about study reading or interpretation, he may send it for an independent reading or he may send the patient to another imaging test where it can be read appropriately.

Michael Yaman, Ph.D.: Thank you so much. Michael, in your experience, are there loopholes in the chain? If so, does it affect different groups of patients?

Michael Levy, MD, PhD: There are some loopholes. The loopholes I notice are in physiotherapy [PT] Rehabilitation, Pain Management, Psychiatry and Urology. You need experts in these fields who are interested in NMOSD because they have unique pathophysiology and different treatment strategies to suit them. These experts are hard to find, but when you do find them, they become useful and these patients gain a lot of that experience.

Mitzi Williams, MD: When we talk about access to care and the social determinants of health, this can also be a barrier. Because for physical therapy, I’ve had many patients say, “I’d like to teach physical therapy, but I can’t afford the co-pay.” There are expenses associated with these specialized treatments that will certainly improve a person’s quality of life significantly, but barriers, such as transportation and financing, can affect their overall care and lifelong quality.

Text edited for clarity