MOG antibody-related disorders: common features and uncommon presentations

Abstract

Myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) have been reported in acute demyelinating encephalomyelitis (ADEM), optic neuritis (ON), and neuromyelitis optica spectrum disorders (NMOSD) in adults and pediatrics. We aimed to delineate the common features of MOG-Ab-related disorders in children and adults, and report uncommon presentations. Twenty-seven consecutive pediatric and adult patients testing positive for MOG-Ab, with a minimum follow-up of 6 months, were included. Comprehensive epidemiological, clinical, radiological, and laboratory data were retrospectively analyzed. Additionally, we compared radiological features between ADEM MOG-Ab-positive patients, and a group of ADEM MOG-Ab-negative ones, recruited during the same period. Among the whole cohort, 13 (48.1%) were pediatric, and 14 (51.9%) were female. MOG-Ab-related disorders comprised eight ADEM, eight ON, five isolated myelitis, four with NMOSD and two patients with multiple sclerosis, at last follow-up. After a median follow-up of 17.8 months, 11 (40.7%) patients presented a relapse. The most frequent clinical phenotype at onset was encephalopathy in pediatrics (53.9%) and myelitis in adults (50%) (p = 0.013). There were no other differences between both groups. When comparing ADEM MOG-Ab positive and negative patients, bilateral thalamic lesions were more often found in the positive group (p = 0.010). Unusual presentations were identified in three patients: patchy spinal cord gadolinium-enhancing lesions, an associated teratoma, and one presented with status epilepticus. MOG-Ab-related disorders shared common clinical and prognostic features, but encompass a spectrum wider than recently reported.

Clinical, Radiologic, and Prognostic Features of Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Autoantibody

“…Our comparison is limited by MOG-IgG myelitis having a greater tendency to affect children than AQP4-IgG, and thus, our MOG-IgG group had a higher proportion of children, some of whom may have reflected our selection of these cases and may have contributed to the higher ADEM rates. [35][36][37] However, the clinical and imaging feature of myelitis that we report with MOG-IgG remained consistent for adults ( Figure 1A and C; Figure 2A) and children ( Figure 1B and D). The patients with MS myelitis were population based, which could affect the comparison, but our findings are consistent with the general clinical observations MS myelitis (mild, accompanied by oligoclonal bands and short MRI lesions).…”

Clinical characteristics and prognosis of myelin oligodendrocyte glycoprotein antibody-seropositive paediatric optic neuritis in China

“…In our cohort, two children had an ON attack during an episode of ADEM. MOG-Abs may play an important role in ADEM clinically29 and the MOG-Ab titre is associated with ADEM severity 30. However, due to the low number of ADEM cases, we were unable to identify a relationship between the titre and severity of ADEM-ON.…”

Clinical features of demyelinating optic neuritis with seropositive myelin oligodendrocyte glycoprotein antibody in Chinese patients

“…MOG antibodies have been reported to be associated with a variety of demyelinating diseases, such as NMOSD,7 ON and acute disseminated encephalomyelitis (ADEM) 20. MOG has been considered as a conformational dependent antibodies for ADEM 21.…”