The journey to a diagnosis can feel uncertain, especially when symptoms first appear or don’t quite fit a clear pattern. Neurologists play a central role in guiding people through this process for conditions like multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).
To help our community better understand who is involved in their health team and how these conditions are identified, what distinguishes them, and what support looks like beyond diagnosis, we spoke with Dr Benson Chen, a neurologist with expertise in neuro-immunological conditions.
- Can you explain your role as a neurologist in caring for people with suspected or confirmed MS?
As a neurologist and neuro-ophthalmologist, I meet lots of patients with optic neuritis (inflammation of the optic nerve, the cable that connects the eyeball to the brain). Optic neuritis is a frequent presenting symptom of MS. My role is to help my colleagues in neurology and ophthalmology make the diagnosis of MS, decide on treatments, and provide ongoing care and follow-up for people living with MS. I work with a team of fantastic neurologists and nurse specialists caring for people with MS in the Auckland region.
- What are NMOSD and MOGAD, and how do they differ from MS?
NMOSD and MOGAD are neuro-immune disorders that affect the brain, optic nerves, and spinal cord. Like MS, they involve inflammation caused by the immune system attacking parts of the central nervous system. Although these conditions can look similar at first, they are caused by different immune mechanisms and require different treatments. This makes an accurate diagnosis very important.
NMOSD often causes severe attacks that may not fully respond to steroids, and some people require plasma exchange (a blood filtration treatment) during a relapse. NMOSD is more common in women and in people of Pacific, Asian, or African descent.
Attacks of MOGAD often respond very well to steroids. However, the long-term course can be variable. Some people with MOGAD have only a single attack and never relapse, while others experience recurrent or more active disease that requires ongoing treatment.
- What symptoms or test results might prompt further investigation?
NMOSD, MOGAD, and MS present with very similar symptoms as they all involve the brain, optic nerve, and spinal cord. However, some features may prompt doctors to look more closely for NMOSD or MOGAD. These include very severe vision loss, especially if both eyes are affected; unusually severe spinal cord attacks; or persistent nausea, vomiting, or hiccups without another clear cause. Brain inflammation causing confusion or drowsiness can also occur in MOGAD. Neurologists and ophthalmologists may also consider how well symptoms respond to standard steroid treatment, as incomplete recovery can suggest a different diagnosis. MRI findings and antibody blood tests help confirm the cause.
- How do advances in imaging and blood tests support diagnosis today?
NMOSD, MOGAD, and MS each have their own diagnostic criteria which incorporate clinical signs and symptoms, MRI findings, blood tests, and spinal fluid tests. Modern MRI scans can show patterns of inflammation that help distinguish MS from NMOSD and MOGAD. Specific blood tests can detect antibodies associated with NMOSD (aquaporin-4 antibody) or MOGAD (MOG antibody), which were not identifiable in the past. These tools allow doctors to confirm the diagnosis more confidently and guide long-term treatment decisions.
- How do you communicate diagnostic uncertainty with patients?
For many people, neurologists can make a confident diagnosis of NMOSD, MOGAD, or MS because the criteria are quite clear. However, some patients have symptoms that do not fit neatly into any of these conditions. In these cases, I explain to patients that further tests and follow-up are needed to rule out other possibilities, which could include rare immune conditions or other serious illnesses. I will arrange close monitoring, including repeat examination and MRI to help clarify the diagnosis safely over time. I also explain that treatments must be chosen carefully, as treatment for one condition could worsen another.
- What reassurance would you give someone awaiting a diagnosis?
It is natural to feel anxious when waiting for a diagnosis, especially while scans or test results are pending. While the timing of results or follow-up scans can sometimes take longer than anyone would like, there are effective treatments available for NMOSD, MOGAD, and MS once a diagnosis is confirmed. With access to modern treatments, conditions like MS are no longer what they used to be, and many people go on to live full, active, and largely normal lives.
- What do you enjoy most about working in MS care?
Following patients over time and supporting them as they navigate the challenges of NMOSD, MOGAD, or MS is incredibly rewarding. Every patient’s journey is different. Some continue many of their usual activities, while others face more limitations. It’s inspiring to see the ways people adapt and manage their condition. I also enjoy working alongside a supportive team of MS specialists in Auckland. Being part of a collaborative environment means that patients benefit from multiple perspectives and expertise, which helps guide their treatment and ongoing management.
- Outside the clinic, what helps you unwind?
I enjoy long, lazy weekends spent with family and friends, exploring good food and trying new wines. Last year I started studying a wine diploma as a hobby, and it’s been fun learning about different wines while getting to taste them along the way. Discovering new flavours and experiences feels a bit like travelling without leaving home! Taking time for these simple pleasures helps me relax and recharge.
We thank Dr. Benson Chen for taking the time to share this information with us.
Last Updated May 21, 2026