Neuroimmunology is the subspecialty of neurology that deals with autoimmune disease of the nervous system — conditions in which the immune system mistakenly targets the brain, spinal cord, optic nerves, peripheral nerves, neuromuscular junction or muscle.
It is one of the fastest-moving areas of medicine in 2026: new disease-modifying therapies (DMTs) for multiple sclerosis (MS), targeted complement and FcRn (neonatal Fc receptor) antagonist treatments for myasthenia gravis (MG), and a steadily growing list of antibody-defined encephalitis syndromes have transformed what was once a frustrating field into one where most patients can expect substantial control of their disease. This page is the East Neurology entry point to the conditions, the modern treatments, and the team that manages them in Sydney.
What is neuroimmunology?
The immune system protects the body from infections and cancers. When it works as designed, it is exquisitely selective — recognising “foreign” and leaving “self” alone. In neuroimmunology, that selectivity breaks down: immune cells, antibodies or both begin attacking parts of the nervous system, producing patterns of inflammation that present clinically as anything from a sudden loss of vision to slowly progressive limb weakness to behavioural change with seizures.
Most autoimmune neurological diseases have three things in common:
🎯 A defined pattern of damage
For example, MS affects oligodendrocytes and myelin; myasthenia gravis blocks the neuromuscular junction; autoimmune encephalitis targets specific neuronal surface receptors.
🔬 A definable immune mechanism
Often a specific autoantibody, sometimes a T-cell-mediated process. Identifying the mechanism is increasingly possible with modern antibody panels.
💊 Treatments that work
Disease-modifying therapies, targeted immunotherapies, plasma exchange, intravenous immunoglobulin (IVIG), and tailored long-term immunosuppression now mean that most neuroimmunological disorders can be controlled, often very effectively.
Neuroimmunology sits at the intersection of clinical neurology, immunology and translational research — which is why patients with these conditions benefit from being seen by a specialist who has trained specifically in the field.
The conditions managed at East Neurology
Central nervous system autoimmune disease
🧠 Multiple sclerosis (MS)
The most common neuroimmunological disease. In 2026, modern treatment is dominated by high-efficacy disease-modifying therapy from the time of diagnosis: anti-CD20 monoclonal antibodies (ocrelizumab, ofatumumab, ublituximab), S1P modulators (ozanimod, ponesimod, fingolimod), cladribine, and natalizumab.
👁️ Neuromyelitis optica spectrum disorder (NMOSD)
A distinct condition from MS — typically AQP4-IgG positive, with severe optic neuritis and longitudinally extensive transverse myelitis. Modern targeted treatments include satralizumab, inebilizumab, eculizumab and ravulizumab.
🧬 MOG antibody-associated disease (MOG-AD)
A separate antibody-defined syndrome that overlaps clinically with both MS and NMOSD but requires different treatment — usually rituximab, IVIG, and steroid tapers. Eculizumab does not work in MOG-AD.
⚡ Autoimmune encephalitis
A growing family of antibody-mediated encephalitides — most prominently anti-NMDA receptor encephalitis, LGI1, CASPR2, GABA-B, AMPAR. Often presenting with psychiatric or behavioural change, seizures, and altered consciousness. First-line treatment with steroids + IVIG + plasma exchange; second-line with rituximab or cyclophosphamide.
🔍 Neurosarcoidosis
Granulomatous CNS disease. Often underdiagnosed because it can mimic almost any other condition. Treatment with prednisolone + steroid-sparing agents; biologic therapy (infliximab) for refractory cases.
Peripheral nervous system autoimmune disease
💪 Myasthenia gravis (MG)
Antibody-mediated disease of the neuromuscular junction. 2026 brings a transformed treatment landscape with FcRn antagonists (efgartigimod, rozanolixizumab), complement inhibitors (eculizumab, ravulizumab, zilucoplan), alongside established treatments (pyridostigmine, prednisolone, IVIG, plasma exchange, thymectomy).
🦵 Guillain-Barré syndrome (GBS) & CIDP
Acute (GBS) and chronic (CIDP — chronic inflammatory demyelinating polyneuropathy) inflammatory demyelinating polyneuropathies. IVIG, plasma exchange, corticosteroids (CIDP only); efgartigimod under investigation for CIDP.
How neuroimmunological disease is diagnosed
Diagnosis in 2026 combines:
🩺 Clinical assessment
Careful history (relapsing or progressive? Symptoms by anatomical localisation? Triggers?), examination, and a clear differential before any investigation. A skilled neurologist will often have a working diagnosis after the initial consultation — the investigations then confirm or refine.
🧲 MRI of the brain and spinal cord
Modern MRI (magnetic resonance imaging) sequences (3D FLAIR, double inversion recovery, MAGNIMS protocols) are highly sensitive for MS, NMOSD and MOG-AD lesions. Spinal cord imaging is essential for NMOSD and many MS presentations.
🧪 Antibody panels
- Aquaporin-4 (AQP4-IgG) for NMOSD
- MOG-IgG (cell-based assay) for MOG-AD
- Acetylcholine receptor antibody, MuSK, LRP4 for myasthenia gravis
- NMDAR, LGI1, CASPR2, GABA-B, AMPAR, GAD65, anti-Hu, anti-Yo, anti-Ma2 and broader paraneoplastic panels for autoimmune encephalitis
💧 CSF (lumbar puncture) analysis
- Oligoclonal bands and IgG index for MS
- White cell count and protein for inflammatory CNS disease
- Antibody testing in serum-negative cases of autoimmune encephalitis
CSF is cerebrospinal fluid, sampled by lumbar puncture.
⚡ Neurophysiology
- Nerve conduction studies (NCS) + EMG (electromyography) for myasthenia gravis, GBS, CIDP, paraneoplastic neuropathies — including single-fibre EMG for MG
- EEG (electroencephalography) for autoimmune encephalitis, looking for characteristic patterns like extreme delta brush
- Evoked potentials (visual, somatosensory) for MS
📷 Imaging and ancillary tests
- FDG-PET / gallium scan for neurosarcoidosis
- Whole-body CT or PET for paraneoplastic syndromes
- Echocardiogram in selected cardiac-immunology overlaps
The 2026 treatment era
What patients can expect today is radically different from a decade ago.
🚀 High-efficacy first-line therapy
For relapsing-remitting MS, NMOSD and MOG-AD, the modern principle is early high-efficacy treatment rather than gradual escalation. The data now consistently show better long-term disability outcomes when potent therapy is started early.
🎯 Targeted biologics
FcRn antagonists, complement inhibitors, and anti-CD20 monoclonal antibodies have moved from research into routine clinical use. PBS (Pharmaceutical Benefits Scheme) access in Australia is steadily expanding.
📈 Personalised escalation
For some patients — particularly those with highly active disease, breakthrough relapses on conventional therapy, or poor tolerability — escalation to autologous haematopoietic stem cell transplantation (AHSCT) is a real option through specialist centres in Sydney and Melbourne.
🤰 Pregnancy and family planning
Modern neuroimmunology practice now includes detailed pre-conception counselling for women on disease-modifying therapy, breastfeeding compatibility data, and post-partum relapse-risk management. This is a core part of the consultation, not an afterthought.
How to refer a patient
For GPs, allied health professionals, and other specialists:
Suspected MS, NMOSD, or MOG-AD: patients with first-episode optic neuritis, transverse myelitis, or other CNS demyelinating presentation should be referred urgently. Early MRI + antibody testing + neurology consultation drives the next steps.
Suspected autoimmune encephalitis: any patient with subacute behavioural change, new psychiatric symptoms, seizures, or memory impairment in a previously well adult — particularly if accompanied by movement disorder, dysautonomia, or sleep disturbance — warrants urgent investigation. Time-to-treatment is the single largest determinant of long-term outcome.
Suspected myasthenia gravis: fluctuating muscle weakness, especially with ocular, bulbar, or fatiguable patterns. Antibody panel + EMG + neurology consultation.
Established disease seeking modern treatment review: patients on older therapies (e.g. interferons, glatiramer for MS; azathioprine alone for MG) often benefit from a review of whether modern higher-efficacy options would be more appropriate.
To refer to East Neurology, please send a written referral via the contact page or call the practice on 02 9388 0615. Both Dr Koren and Dr Granot accept new referrals.
Meet the team
🧠 Dr Tal Koren — Consultant Neurologist (Neuroimmunology)
Dr Koren completed his neuroimmunology fellowship at Royal Prince Alfred Hospital and continues academic work with the Brain and Mind Centre, University of Sydney MS research group. He is currently undertaking a Master of Philosophy at USyd studying MRI biomarkers of MS disease progression. At East Neurology he offers patients modern, subspecialty neuroimmunology care — an accurate diagnosis and access to the newest treatments for MS and related conditions.
🩺 Dr Ron Granot — Senior Neurologist & Practice Founder
Dr Granot is a consultant neurologist providing the practice’s general neurology, headache, autonomic, and medicolegal services, and works closely with Dr Koren on shared-care patients where a multi-symptom workup is needed.
Frequently asked questions
Do I need a referral?
Yes — a current GP or specialist referral is required for Medicare-rebatable consultation. New patients should ask their GP for a referral specifically to Dr Tal Koren or Dr Ron Granot at East Neurology, Bondi Junction.
What does it cost?
East Neurology is a fully private practice. We do not bulk bill — including DVA cardholders. Medicare rebates are processed same-day so any rebate returns directly to your nominated account.
How quickly can I be seen?
Urgent neuroimmunology presentations (suspected new MS, optic neuritis, encephalitis, MG crisis) are usually accommodated within a week. Routine consultations 2–4 weeks. Telehealth available where appropriate.
Can I be seen for a second opinion?
Yes. Patients already under another neurologist’s care are welcome to request a second-opinion consultation, particularly for treatment-resistant disease or where a change in therapy is being considered.
Will I see the same neurologist every visit?
For neuroimmunology patients, Dr Koren is the primary consultant; Dr Granot is available for cross-cover and combined consults where the differential overlaps with general neurology, headache, or autonomic disorders.
Where are you located?
Suite 301, Harley Place, 251 Oxford Street, Bondi Junction NSW 2022. Easy walk from Bondi Junction station and bus interchange. Parking available nearby.
The aim at East Neurology is straightforward: an accurate diagnosis, the most effective modern treatment for your condition, and a neurologist who stays with you for the long term.
This page is general information about neuroimmunology services at East Neurology. It is not personal medical advice. Please contact the practice to discuss your specific situation.
Book an appointment
Ask your GP for a referral to Dr Tal Koren or Dr Ron Granot at East Neurology, then get in touch — we’ll help with the rest. New patients, general neurology and second opinions are all welcome.
Or call 02 9388 0615. East Neurology is a private practice; we do not bulk bill (including DVA cardholders) — Medicare claims are processed for you on the day.