Goals and Design of a Dedicated Tertiary Care Centre NMOSD/MOGAD Clinic

ObjectiveTo review and share the process and design of patient clinic dedicated to the care of patients with Neuromyelitis Optica Spectrum Disorder (NMOSD) and Myelin Oligodendrocyte Antibody-Associated Disease (MOGAD). BackgroundPatients with NMOSD and MOGAD have time-sensitive and specific needs that may not be adequately addressed in a large, undifferentiated demyelinating disease clinic. This includes rapid assessment in suspected NMSOD relapses, arranging relapse therapy such as plasmapheresis, and enrolment in trials of putative therapies. Design/MethodsProviders with the greatest expertise and complement of NMOSD and MOGAD patients, in consultation with providers in other provincial centers, came to a consensus about patient criteria (suspected, probable, and confirmed MOGAD and NMOSD), triage acuity, visit frequency, transition from inpatient to clinic processes, Neuro-ophthalmology participation, trainee involvement, and nursing support to oversee treatment pathways. ResultsThe University of Calgary NMOSD/MOGAD clinic was developed to run once monthly staffed by three dedicated staff. Eligible patients are those with confirmed or probable seropositive or seronegative NMOSD, or MOGAD, including those with ADEM, cortical encephalitis, recurrent optic neuritis and/or myelitis AFTER appropriate investigations. Patients with suspected or newly confirmed NMOSD/MOGAD receiving acute relapse treatment requiring medication tapering and maintenance therapy, or those referred from Ophthalmology or Neurology actively relapsing and needing acute treatment guidance, will be deemed urgent. Patients with probable or newly confirmed MOGAD/NMOSD and a recent suspicious event successfully treated who may have already started a maintenance therapy, or patients with probable NMOSD in remission, but not on maintenance therapy will be deemed semi-urgent. ConclusionsWe believe focused NMOSD/MOGAD care directed through a dedicated clinic with appropriate staffing and processes will result in better outcomes and patient satisfaction. We will review clinic outcomes and issues at 6 months intervals after initiation.