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Antibodies to MOG in adults with inflammatory demyelinating disease of the CNS.

Kim SM, Woodhall MR, Kim JS, Kim SJ, Park KS, Vincent A, Lee KW, Waters P - Neurol Neuroimmunol Neuroinflamm (2015)

Bottom Line: Moreover, MOG-Ab patients did not meet the diagnostic criteria for definite neuromyelitis optica (NMO) and had less spinal cord involvement than the AQP4-Ab group.Four patients (23.5%) had poor visual outcomes (<0.2) or paraplegia.The radiologic as well as clinical manifestations of MOG-Ab patients can be useful in their differential diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology (S.-M.K., J.-S.K., K.S.P., K.-W.L.) and Ophthalmology (S.-J.K.), Seoul National University College of Medicine, Seoul, Republic of Korea; Nuffield Department of Clinical Neurosciences (M.R.W., A.V., P.W.), John Radcliffe Hospital, Oxford, United Kingdom; and Department of Neurology (K.S.P.), Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea.

ABSTRACT

Objective: To evaluate the clinical relevance of myelin oligodendrocyte glycoprotein antibody (MOG-Ab) in a cohort of adults with inflammatory demyelinating disease (IDD) of the CNS.

Methods: Live cell-based assays for MOG-Ab (IgG1 subset) and antibody to aquaporin-4 (AQP4-Ab) were performed in a cohort of 270 adult patients with IDD and 72 controls. Patients were first grouped by positive antibody result as MOG-Ab or AQP4-Ab, and the remainder were grouped by published diagnostic criteria.

Results: Seventeen patients with IDD (6.3%) had MOG-Abs and 49 patients (18.1%) had AQP4-Abs; none had both antibodies. The MOG-Ab patients predominantly manifested with isolated symptoms of optic neuritis (83%). One-third of these patients experienced relapses, which involved only the optic nerve, and all relapsed within 1 year of disease onset. At onset, MRI in the MOG-Ab group uniquely demonstrated perineural enhancement, extending to the soft tissues around the optic nerves (33%). Although about 30% of MOG-Ab patients had brain MRI lesions, they had fewer periventricular lesions than the 26 patients with relapsing-remitting multiple sclerosis (MS); none of these lesions were ovoid or perpendicular to the ventricle. Moreover, MOG-Ab patients did not meet the diagnostic criteria for definite neuromyelitis optica (NMO) and had less spinal cord involvement than the AQP4-Ab group. Four patients (23.5%) had poor visual outcomes (<0.2) or paraplegia.

Conclusions: MOG-Abs may be a disease-specific biomarker in adult patients with IDD who have a disease distinct from NMO or MS. The radiologic as well as clinical manifestations of MOG-Ab patients can be useful in their differential diagnosis.

No MeSH data available.


Related in: MedlinePlus

Brain MRI findings in patients with MOG-AbExtensive brain lesions with large diameter (A and B), posterior reversible encephalopathy–like lesions (C and D), and symmetric brainstem lesions involving pontine tegmentum (E–G) were found in the myelin oligodendrocyte glycoprotein antibody (MOG-Ab) group. A, C, D, F, and G = fluid-attenuated inversion recovery; B = T2-weighted image; E = double inversion recovery.
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Figure 3: Brain MRI findings in patients with MOG-AbExtensive brain lesions with large diameter (A and B), posterior reversible encephalopathy–like lesions (C and D), and symmetric brainstem lesions involving pontine tegmentum (E–G) were found in the myelin oligodendrocyte glycoprotein antibody (MOG-Ab) group. A, C, D, F, and G = fluid-attenuated inversion recovery; B = T2-weighted image; E = double inversion recovery.

Mentions: The most common symptomatic clinical manifestation in the MOG group was isolated ON (83.3%; table 1). Although most of these cases with isolated ON were recurrent or bilaterally simultaneous/consecutive, 4 of them manifested as a single attack of unilateral ON. The visual acuity (VA) was severely affected at nadir, with VA less than or equal to 0.2 in 75% (9/12) of patients. Perineural enhancement that extended around the soft tissue of the optic nerve, visualized by MRI, was found in 33% of patients in the MOG group (table 1 and figure 2). This pattern of orbital inflammation was more prominent in their first ON attacks than in subsequent ON attacks (data not shown). Brain MRI abnormalities were found in only 5 (29%) of these patients, and they were asymptomatic in 3 cases (figures 3 and 4). They tended to be large (>3 cm) and involve white matter and the internal capsule (figure 3, A and B); in some cases, they mimicked the lesions of posterior reversible encephalopathy (figure 3, C and D). There were also symmetric brainstem lesions involving pontine tegmentum (figure 3, E–G). There were no ovoid lesions or lesions perpendicular to the ventricles as typically found in MS.


Antibodies to MOG in adults with inflammatory demyelinating disease of the CNS.

Kim SM, Woodhall MR, Kim JS, Kim SJ, Park KS, Vincent A, Lee KW, Waters P - Neurol Neuroimmunol Neuroinflamm (2015)

Brain MRI findings in patients with MOG-AbExtensive brain lesions with large diameter (A and B), posterior reversible encephalopathy–like lesions (C and D), and symmetric brainstem lesions involving pontine tegmentum (E–G) were found in the myelin oligodendrocyte glycoprotein antibody (MOG-Ab) group. A, C, D, F, and G = fluid-attenuated inversion recovery; B = T2-weighted image; E = double inversion recovery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608758&req=5

Figure 3: Brain MRI findings in patients with MOG-AbExtensive brain lesions with large diameter (A and B), posterior reversible encephalopathy–like lesions (C and D), and symmetric brainstem lesions involving pontine tegmentum (E–G) were found in the myelin oligodendrocyte glycoprotein antibody (MOG-Ab) group. A, C, D, F, and G = fluid-attenuated inversion recovery; B = T2-weighted image; E = double inversion recovery.
Mentions: The most common symptomatic clinical manifestation in the MOG group was isolated ON (83.3%; table 1). Although most of these cases with isolated ON were recurrent or bilaterally simultaneous/consecutive, 4 of them manifested as a single attack of unilateral ON. The visual acuity (VA) was severely affected at nadir, with VA less than or equal to 0.2 in 75% (9/12) of patients. Perineural enhancement that extended around the soft tissue of the optic nerve, visualized by MRI, was found in 33% of patients in the MOG group (table 1 and figure 2). This pattern of orbital inflammation was more prominent in their first ON attacks than in subsequent ON attacks (data not shown). Brain MRI abnormalities were found in only 5 (29%) of these patients, and they were asymptomatic in 3 cases (figures 3 and 4). They tended to be large (>3 cm) and involve white matter and the internal capsule (figure 3, A and B); in some cases, they mimicked the lesions of posterior reversible encephalopathy (figure 3, C and D). There were also symmetric brainstem lesions involving pontine tegmentum (figure 3, E–G). There were no ovoid lesions or lesions perpendicular to the ventricles as typically found in MS.

Bottom Line: Moreover, MOG-Ab patients did not meet the diagnostic criteria for definite neuromyelitis optica (NMO) and had less spinal cord involvement than the AQP4-Ab group.Four patients (23.5%) had poor visual outcomes (<0.2) or paraplegia.The radiologic as well as clinical manifestations of MOG-Ab patients can be useful in their differential diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology (S.-M.K., J.-S.K., K.S.P., K.-W.L.) and Ophthalmology (S.-J.K.), Seoul National University College of Medicine, Seoul, Republic of Korea; Nuffield Department of Clinical Neurosciences (M.R.W., A.V., P.W.), John Radcliffe Hospital, Oxford, United Kingdom; and Department of Neurology (K.S.P.), Seoul National University Bundang Hospital, Gyeonggi, Republic of Korea.

ABSTRACT

Objective: To evaluate the clinical relevance of myelin oligodendrocyte glycoprotein antibody (MOG-Ab) in a cohort of adults with inflammatory demyelinating disease (IDD) of the CNS.

Methods: Live cell-based assays for MOG-Ab (IgG1 subset) and antibody to aquaporin-4 (AQP4-Ab) were performed in a cohort of 270 adult patients with IDD and 72 controls. Patients were first grouped by positive antibody result as MOG-Ab or AQP4-Ab, and the remainder were grouped by published diagnostic criteria.

Results: Seventeen patients with IDD (6.3%) had MOG-Abs and 49 patients (18.1%) had AQP4-Abs; none had both antibodies. The MOG-Ab patients predominantly manifested with isolated symptoms of optic neuritis (83%). One-third of these patients experienced relapses, which involved only the optic nerve, and all relapsed within 1 year of disease onset. At onset, MRI in the MOG-Ab group uniquely demonstrated perineural enhancement, extending to the soft tissues around the optic nerves (33%). Although about 30% of MOG-Ab patients had brain MRI lesions, they had fewer periventricular lesions than the 26 patients with relapsing-remitting multiple sclerosis (MS); none of these lesions were ovoid or perpendicular to the ventricle. Moreover, MOG-Ab patients did not meet the diagnostic criteria for definite neuromyelitis optica (NMO) and had less spinal cord involvement than the AQP4-Ab group. Four patients (23.5%) had poor visual outcomes (<0.2) or paraplegia.

Conclusions: MOG-Abs may be a disease-specific biomarker in adult patients with IDD who have a disease distinct from NMO or MS. The radiologic as well as clinical manifestations of MOG-Ab patients can be useful in their differential diagnosis.

No MeSH data available.


Related in: MedlinePlus