Sebastian López

One unintended consequence of the rise of tele-neurohospitalists and shift-based neurology models is that no one clearly owns the patient’s care beyond the acute hospitalization. Too often it’s 5 days of IV steroids… and adios. I frequently see patients with MS, NMOSD, MOGAD, or autoimmune encephalitis discharged with, “Follow up with neuroimmunology ASAP.” No steroid taper (when appropriate), no plan for relapse prevention, and no baseline screening to facilitate long-term immunotherapy. Some return weeks later with another preventable relapse. Hospitalization should be more than treating an attack. If steroids aren’t working, should PLEX, IL-6 inhibition, or complement inhibition already be considered when appropriate? The workup for long-term immunotherapy, vaccination review should begin before discharge. The inpatient admission is often the best opportunity to change the trajectory of a chronic neuroimmunologic disease. Let’s not waste it. Neuroimmunologists want to see these patients. Many of us will make every effort to expedite urgent referrals if contacted directly. Patient advocacy organizations such as the National MS Society and disease-specific organizations for NMOSD and MOGAD can also help identify local specialists. Let’s use those resources instead of simply writing, “Follow up with neuroimmunology ASAP.”

Congratulations to @max_herman on his graduation! We’re incredibly proud of all he has accomplished during his Autoimmune Neurology fellowship and can’t wait to see what’s next as he returns to Emory. @Mayo_AING – at Jacksonville Beach, FL

This is an excellent review on this topic ! Persistent diagnostic uncertainty in suspected neuroinflammation should trigger genetic testing. You can’t diagnose what you don’t test.