Association of Disease Characteristics with Utilization of Behavioral Medicine in Patients with NMOSD and MOGAD
Carol Swetlik1, Devon Conway2, Julie Widmar2, Amy Kunchok2, Grace Tworek2, Amy Sullivan2, Rachel Galioto2, Albert Aboseif1, Justin Abbatemarco2
1Cleveland Clinic - Neurological Institute, 2Cleveland Clinic - Mellen Center
Objective:
To evaluate utilization of behavioral medicine in patients with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein-IgG-associated disorder (MOGAD).
Background:
The relationship between disease characteristics, utilization of behavioral medicine, and other healthcare services has not been well-characterized in patients with NMOSD/MOGAD.
Design/Methods:
In this retrospective cohort study, patients with NMOSD/MOGAD confirmed by a neuroimmunology clinic with available clinical data between June 2015 and April 2022 were identified. Relevant variables were collected, including number of behavioral medicine appointments, diagnosis, number of other healthcare visits (admissions, emergency room visits, neurology appointments, outpatient physical and occupational therapy [PT/OT] visits), and number and type of relapses (brainstem, transverse myelitis, and optic neuritis). Nonparametric t-tests were performed to compare characteristics of patients who did and did not use behavioral medicine. Pearson correlations were used to explore relationships between disease characteristics and number of behavioral medicine appointments.
Results:
196 patients (70.9% NMOSD [92.8% aquaporin-4 antibody positive], 29.1% MOGAD) were identified (median duration of symptoms 8.4 years, IQR [4.6, 16.4 years]). Of these, 21 patients (90.5% NMOSD, 9.5% MOGAD) attended at least one outpatient behavioral medicine appointment. These patients had more emergency room visits (median 3, IQR [1, 8]) than non-attendees (median 1, IQR [0, 2]) (p = .04). No significant difference was detected regarding number or type of relapse or utilization of other healthcare services (for all, p > .05). Brainstem flares and number of PT/OT visits correlated with number of behavioral medicine appointments (r = .72 and r = .56, respectively, p < .05).
Conclusions:
Patients with NMOSD/MOGAD who received behavioral medicine services had greater emergency room utilization than those who did not. In our cohort, nearly 1 in 8 patients attended behavioral medicine appointments. Screening for mental health disorders in neurology clinics remains critical to appropriately identify and treat NMOSD/MOGAD patients with behavioral comorbidities.