{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:50:46Z","timestamp":1791903046605,"version":"4.3.4"},"reference-count":12,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100008746","name":"National Cancer Center","doi-asserted-by":"publisher","award":["2510580"],"award-info":[{"award-number":["2510580"]}],"id":[{"id":"10.13039\/100008746","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Magnetic resonance imaging (MRI) is widely used to support relapse diagnosis in neuromyelitis optica spectrum disorder (NMOSD), yet some patients present with attack\u2010like symptoms without corresponding lesions. We assessed serum glial fibrillary acidic protein (sGFAP) levels in MRI\u2010negative attack\u2010like episodes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively analyzed aquaporin\u20104\u2010IgG\u2013positive NMOSD patients presenting with relapse\u2010like symptoms but without corresponding new MRI lesions. sGFAP was measured from stored serum collected at presentation and converted to demographic\u2010adjusted\n                      <jats:italic>z<\/jats:italic>\n                      \u2010scores. A predefined attack\u2010associated threshold (\n                      <jats:italic>z<\/jats:italic>\n                      \u2010score \u2265\u20093.0) was based on prior work.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We identified 39 MRI\u2010negative attack\u2010like episodes from 34 patients. Most episodes were clinically mild or subjective, with objective worsening observed in 23%. Eight episodes (21%) showed elevated sGFAP levels (median\n                      <jats:italic>z<\/jats:italic>\n                      \u2010score 4.56 [1748\u2009pg\/mL]). Compared with episodes without elevated sGFAP, these episodes occurred closer to prior attacks (8 vs. 33\u2009months) and more frequently met objective worsening criteria (50% vs. 16%). In all episodes with elevated sGFAP, remission samples showed normalization below the threshold.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Marked sGFAP elevation in a subset of MRI\u2010negative episodes suggests that some events may represent relapse not captured by conventional imaging. sGFAP may serve as a complementary biomarker to support attack identification when clinical and MRI findings are inconclusive.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ene.70784","type":"journal-article","created":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T14:27:34Z","timestamp":1791901654000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Blood Glial Fibrillary Acidic Protein in\n                    <scp>MRI<\/scp>\n                    \u2010Negative Attack\u2010Like Episodes of Neuromyelitis Optica Spectrum Disorder"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0679-0918","authenticated-orcid":false,"given":"Su\u2010Hyun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Neurology Research Institute and Hospital of National Cancer Center  Goyang Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3267-2085","authenticated-orcid":false,"given":"Jieun","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Neurology Research Institute and Hospital of National Cancer Center  Goyang Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7112-5957","authenticated-orcid":false,"given":"Rosah May Palermo","family":"Payumo","sequence":"additional","affiliation":[{"name":"Department of Neurology Research Institute and Hospital of National Cancer Center  Goyang Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae\u2010Won","family":"Hyun","sequence":"additional","affiliation":[{"name":"Department of Neurology Research Institute and Hospital of National Cancer Center  Goyang Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8672-8419","authenticated-orcid":false,"given":"Ho Jin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology Research Institute and Hospital of National Cancer Center  Goyang Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"issue":"5","key":"e_1_2_10_2_1","article-title":"Early Indicators of Relapses vs Pseudorelapses in Neuromyelitis Optica Spectrum Disorder","volume":"3","author":"Kessler R. 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M.","year":"2021","journal-title":"Therapeutic Advances in Neurological Disorders"},{"key":"e_1_2_10_5_1","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1177\/13524585231172145","article-title":"Attack Adjudication in Neuromyelitis Optica Spectrum Disorder: Substantiation of Criteria by Magnetic Resonance Imaging and Biomarkers in N\u2010MOmentum","volume":"29","author":"Weinshenker B. G.","year":"2023","journal-title":"Multiple Sclerosis"},{"key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"e1299","DOI":"10.1212\/WNL.0000000000008160","article-title":"Serum GFAP and Neurofilament Light as Biomarkers of Disease Activity and Disability in NMOSD","volume":"93","author":"Watanabe M.","year":"2019","journal-title":"Neurology"},{"issue":"4","key":"e_1_2_10_7_1","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1177\/13524585211024978","article-title":"Longitudinal Follow\u2010Up of Serum Biomarkers in Patients With Neuromyelitis Optica Spectrum Disorder","volume":"28","author":"Kim H.","year":"2022","journal-title":"Multiple Sclerosis"},{"issue":"5","key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1002\/ana.26067","article-title":"Serum Glial Fibrillary Acidic Protein: A Neuromyelitis Optica Spectrum Disorder Biomarker","volume":"89","author":"Aktas O.","year":"2021","journal-title":"Annals of Neurology"},{"issue":"2","key":"e_1_2_10_9_1","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1001\/jamaneurol.2024.4400","article-title":"Blood\u2010Based Biomarkers for Identifying Disease Activity in AQP4\u2010IgG\u2010Positive Neuromyelitis Optica Spectrum Disorder","volume":"82","author":"Kim S. H.","year":"2025","journal-title":"JAMA Neurology"},{"issue":"10206","key":"e_1_2_10_10_1","doi-asserted-by":"crossref","first-page":"1352","DOI":"10.1016\/S0140-6736(19)31817-3","article-title":"Inebilizumab for the Treatment of Neuromyelitis Optica Spectrum Disorder (N\u2010MOmentum): A Double\u2010Blind, Randomised Placebo\u2010Controlled Phase 2\/3 Trial","volume":"394","author":"Cree B. A. C.","year":"2019","journal-title":"Lancet"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awaf433"},{"issue":"3","key":"e_1_2_10_12_1","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/S1474-4422(22)00009-6","article-title":"Serum Neurofilament Light Chain for Individual Prognostication of Disease Activity in People With Multiple Sclerosis: A Retrospective Modelling and Validation Study","volume":"21","author":"Benkert P.","year":"2022","journal-title":"Lancet Neurology"},{"issue":"3","key":"e_1_2_10_13_1","doi-asserted-by":"crossref","DOI":"10.1212\/NXI.0000000000000965","article-title":"Investigating the Presence of Interattack Astrocyte Damage in Neuromyelitis Optica Spectrum Disorder: Longitudinal Analysis of Serum Glial Fibrillary Acidic Protein","volume":"8","author":"Hyun J. 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