{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T23:13:47Z","timestamp":1770333227977,"version":"3.49.0"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"11","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":95,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq Neuropsiquiatr"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Neuromyelitis optica spectrum disorder (NMOSD) is a severe autoimmune demyelinating disease characterized by a high risk of relapse and disability. In cases positive for aquaporin 4-immunoglobulin G (AQP4-IgG), long-term immunosuppression is the established standard. However, the management of double-seronegative NMOSD remains controversial due to limited data. Although some authors propose treatment discontinuation in patients with prolonged remission, there are no reliable predictors of sustained disease inactivity. Given the unpredictability and severity of the relapses, even after a decade of stability, and the lack of robust evidence supporting safe cessation, we argue that maintenance immunotherapy should remain the standard of care in most cases. The risks of disease reactivation outweigh the potential benefits of treatment withdrawal. Until validated biomarkers or clinical tools for individualized risk stratification emerge, the default approach should prioritize sustained disease suppression.<\/jats:p>","DOI":"10.1055\/s-0045-1814370","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T23:59:31Z","timestamp":1770249571000},"page":"001-004","source":"Crossref","is-referenced-by-count":1,"title":["Double-seronegative neuromyelitis optica: it is not possible to interrupt treatment after 10 years of stability"],"prefix":"10.1055","volume":"83","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9732-7637","authenticated-orcid":false,"given":"Vit\u00f3ria","family":"Pimentel","sequence":"additional","affiliation":[{"name":"Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Hospital S\u00e3o Lucas, Departamento de Neurologia, Porto Alegre RS, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9981-3620","authenticated-orcid":false,"given":"Jefferson","family":"Becker","sequence":"additional","affiliation":[{"name":"Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Hospital S\u00e3o Lucas, Departamento de Neurologia, Porto Alegre RS, Brazil."},{"name":"Pontif\u00edcia Universidade Cat\u00f3lica do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre RS, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"publisher","first-page":"206","DOI":"10.1002\/ana.24554","article-title":"Neuromyelitis optica: Evaluation of 871 attacks and 1,153 treatment courses","volume":"79","author":"I Kleiter","year":"2016","journal-title":"Ann Neurol"},{"issue":"09","key":"ref2","doi-asserted-by":"publisher","first-page":"2792","DOI":"10.1111\/ene.15425","article-title":"Immunosuppressant and neuromyelitis optica spectrum disorder: optimal treatment duration and risk of discontinuation","volume":"29","author":"R Li","year":"2022","journal-title":"Eur J Neurol"},{"issue":"02","key":"ref3","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1212\/NXI.0000000000000947","article-title":"Discontinuation of Immunosuppressive Therapy in Patients With Neuromyelitis Optica Spectrum Disorder With Aquaporin-4 Antibodies [published correction appears in Neurol Neuroimmunol Neuroinflamm. 2021 Apr 19;8(4):e1013. doi: 10.1212\/NXI.0000000000001013.]","volume":"8","author":"S H Kim","year":"2021","journal-title":"Neurol Neuroimmunol Neuroinflamm"},{"issue":"06","key":"ref4","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1097\/NRL.0000000000000095","article-title":"Severe Relapse After Cessation of Immunosuppressive Therapy in a Patient With Neuromyelitis Optica Spectrum Disorder","volume":"21","author":"J W Hyun","year":"2016","journal-title":"Neurologist"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/1742-2094-9-14","article-title":"Contrasting disease patterns in seropositive and seronegative neuromyelitis optica: A multicentre study of 175 patients","volume":"9","author":"S Jarius","year":"2012","journal-title":"J Neuroinflammation"},{"issue":"48","key":"ref6","doi-asserted-by":"publisher","first-page":"e13100","DOI":"10.1097\/MD.0000000000013100","article-title":"A multi-facet comparative analysis of neuromyelitis optica spectrum disorders in patients with seropositive and seronegative AQP4-IgG","volume":"97","author":"X Wang","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"578591","DOI":"10.1016\/j.jneuroim.2025.578591","article-title":"Comparison of clinical features of aquaporin-4 positive neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein associated disorder (MOGAD), and double seronegative NMOSD - 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