Update on the diagnosis and treatment of neuromyelitis optica: Recommendations of the Neuromyelitis Optica Study Group (NEMOS)

Neuromyelitis optica (NMO, Devic's syndrome), long considered a clinical variant of multiple sclerosis, is now regarded as a distinct disease entity. Major progress has been made in the diagnosis and treatment of NMO since aquaporin-4 antibodies (AQP4-Ab; also termed NMO-IgG) were first described in 2004. In this review, the Neuromyelitis Optica Study Group (NEMOS) summarizes recently obtained knowledge on NMO and highlights new developments in its diagnosis and treatment, based on current guidelines, the published literature and expert discussion at regular NEMOS meetings. Testing of AQP4-Ab is essential and is the most important test in the diagnostic work-up of suspected NMO, and helps to distinguish NMO from other autoimmune diseases. Furthermore, AQP4-Ab testing has expanded our knowledge of the clinical presentation of NMO spectrum disorders (NMOSD). In addition, imaging techniques, particularly magnetic resonance imaging of the brain and spinal cord, are obligatory in the diagnostic workup. It is important to note that brain lesions in NMO and NMOSD are not uncommon, do not rule out the diagnosis, and show characteristic patterns. Other imaging modalities such as optical coherence tomography are proposed as useful tools in the assessment of retinal damage. Therapy of NMO should be initiated early. Azathioprine and rituximab are suggested as first-line treatments, the latter being increasingly regarded as an established therapy with long-term efficacy and an acceptable safety profile in NMO patients. Other immunosuppressive drugs, such as methotrexate, mycophenolate mofetil and mitoxantrone, are recommended as second-line treatments. Promising new therapies are emerging in the form of anti-IL6 receptor, anti-complement or anti-AQP4-Ab biologicals

Assessing spatial associations between perceptions of landscape value and climate change risk for use in climate change planning

This study examines spatially referenced perceived landscape values and climate change risks collected through public participation geographic information systems for potential use in climate change planning. Using survey data from the Southern Fleurieu Peninsula, South Australia, we present a method for identifying perceived landscape values and climate change risks to describe and quantify their spatial associations. Two spatial data models—vector and raster—and two analytical methods—Jaccard coefficients and spatial cross-correlations were used to describe the spatial associations. Results indicate that perceptions of climate change risk are driven, in part, by the values people assign or hold for places on the landscape. Biodiversity and intrinsic landscape values have strong spatial association with biodiversity loss risk while recreation values have strong spatial association with riparian flooding, sea-level rise and wave action risks. Other landscape values show weak to no spatial association with perceived climate change risks. The methodology described in this research provides a mechanism for government agencies to develop place-based adaptation strategies based on these associations