Abstract
Aquaporin-4 (AQP4) antibody, or neuromyelitis optica (NMO)–immunoglobulin G (IgG), is an important diagnostic biomarker of definite and limited forms of NMO, collectively referred to as NMO spectrum disorders (NMOSD),1 but its detection in this syndrome is only 50% to 90%. AQP4 antibody–seronegative NMO poses a diagnostic challenge in clinical practice and represents a source of uncertainty in NMO clinical research.2 Assay sensitivity and patient selection may contribute to clinical uncertainty, but it is unresolved whether there are unique features of AQP4 antibody–negative NMO that are distinct from seropositive NMO. The authors thank Prof. Brian G. Weinshenker, Department of Neurology, Mayo Clinic, Rochester, MN, for suggestions.
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