Clinical Profile of Anti-Myelin Oligodendrocyte Glycoprotein Antibody Seropositive Cases of Optic Neuritis

Abstract

We have studied the clinical picture of anti-aquaporin antibody (AQP4-Ab)-and anti-myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-positive optic neuritis. However, optic neuritis associated with MOG-Abs has not been elucidated using new methods such as cell-based assay. Hence, we conducted a comprehensive investigation on its clinical profile. Serum samples from 70 patients (17 males and 53 females, mean age 43.1 years) with optic neuritis were tested for MOG-Abs by cell-based assay. In MOG-Ab seropositive patients, the disease type, recurrence status, and visual function outcome were analysed. Among 70 patients, 18 were MOGAb seropositive. The 18 patients comprised 2 with chronic relapsing inflammatory optic neuropathy, 2 with AQP4-Ab seropositive optic neuritis (neuromyelitis optica), 12 with idiopathic optic neuritis, and 2 with optic neuritis associated with multiple sclerosis. Excluding two cases that were also AQP4-Ab seropositive, MOG-Ab seropositive cases had relatively favourable visual acuity outcome (although not significantly different from seronegative cases) but had significant residual visual field deficit (p = 0.0015). Furthermore, the number of relapses of optic neuritis per year was significantly greater in MOG-Ab seropositive cases than in seronegative cases (0.82 vs. 0.40; p = 0.0005). MOG-Abs may contribute to the heterogeneous clinical picture of optic neuritis, and although visual acuity outcome is favourable, there is a tendency of residual visual field deficit and a possibility of repeated relapses.

Pattern Recognition of the Multiple Sclerosis Syndrome

“…The exquisite steroid sensitivity of MOG-ON, reminiscent of that observed with CRION, raises the possibility that CRION could be a manifestation of the MOG-inflammatory demyelinating disease spectrum. This observation was indeed confirmed in more than one study where patients with a clinical diagnosis of CRION or RION were found to have the MOG antibody [ 43 , 51 , 61 , 62 ]. The potential course of demyelinating optic neuropathy is summarized in Figure 1 .…”

“…In both the MOG-ON and the MS-ON groups, visual acuity loss during a relapse and the long-term outcome past one year were similar, but they were worse in AQP4-ON group. The less severe prognosis of MOG-ON was confirmed in a study by Matsuda et al, who also showed that the residual deficit was commonly present due to an increased number of relapses per year [ 62 ]. A 2017 study by Stiebel-Kalish et al compared the visual acuity, field defect, and thickness of the retinal nerve fiber layer over time between a group of MOG-ON and AQP4-ON.…”

“…Brain MRI is typically normal [ 59 ]. Recently, a number of patients with CRION or RION were found to have the MOG antibody [ 43 , 51 , 61 , 62 ]. In summary, the most notable distinguishing characteristics between RION and CRION available to date remains the progression in between relapses and steroid responsiveness, recognizing the lack of agreement on the definition.…”

Epidemiologic and Clinical Characteristics of Optic Neuritis in Japan

“…With respect to VA after treatment, the response to treatment was evidently good in the MOG-Abepositive group, with visual recovery to 0.5 (decimal VA, 0.3) or higher in 82% of the patients and 0.2 (decimal VA, 0.7) or higher in 74% of patients. Matsuda et al 10 reported good visual outcomes in MOG-Abepositive optic neuritis patients. Furthermore, Zhao et al 23 also reported good VA outcomes after treatment in MOG-Abepositive optic neuritis patients.…”

“…Endo et al 34 reported that in Japan, AQP4-Abepositive optic neuritis recurs 1.5AE2.3 times, and 46.8% of all patients show a bilateral decrease in VA. For MOG-Abepositive optic neuritis also, a high percentage of bilateral recurrent disease has been reported. 10,22,23,51 Therefore, in evaluating optic neuritis, laterality and recurrence are very important findings. Of 531 patients analyzed herein, 353 (66.5%) showed primary (first episode of) optic neuritis, and long-term follow-up was not available for these patients.…”