Executive Summary of the Malaysian consensus statements for the diagnosis and management of neuromyelitis optica spectrum disorder (NMOSD)

Neuromyelitis optica spectrum disorder (NMOSD) is a rare immune-mediated astrocytopathy associated with recurrent inflammatory attacks of the central nervous system and substantial morbidity if not diagnosed and treated promptly. This Executive Summary presents the key recommendations and summary of the supporting evidence from the Malaysian Consensus Statements for the Diagnosis and Management of NMOSD. A modified Delphi methodology involving a multidisciplinary panel from public and private healthcare institutions was employed. Consensus statements were developed through structured discussions, iterative review, and three rounds of anonymous voting with a predefined agreement threshold of 75%. Subsequent refinement included supplementary considerations for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and double-seronegative NMOSD. International evidence and guideline recommendations were contextualised to reflect Malaysian clinical practice and healthcare resource considerations. The final consensus comprised 36 statements across 9 domains, with an additional 3 supplementary statements relating to MOGAD and double-seronegative NMOSD. It addressed diagnosis, treatment selection, relapse management, biologic monitoring, vaccination, and biologic use in special populations. The recommendations emphasise the continued use of established diagnostic criteria and highlight the central role of aquaporin-4 immunoglobulin G (AQP4-IgG) serostatus for diagnosis and therapeutic decisions. Approved biologic therapies are supported for AQP4-IgG-seropositive NMOSD, with guidance provided for the use of off-label immunosuppression in resource-variable settings. These Malaysian consensus statements provide a practical and locally relevant framework to support more consistent and evidence-based NMOSD care. The full consensus document and detailed evidence summaries are available online via the Malaysian Society of Neurosciences website.