Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease: practical considerations

Abstract

The field of central nervous system (CNS) inflammatory diseases has recently broadened to include a new condition associated with pathogenic serum antibodies against myelin oligodendrocyte glycoprotein (MOG). This is distinct from multiple sclerosis (MS) and aquaporin-4 (AQP4) antibody neuromyelitis optica spectrum disorders (NMOSD). MOG antibody-associated disease phenotypes are varied and range from classical neuromyelitis optica to acute demyelinating encephalomyelitis and cortical encephalitis. The diagnosis depends on using a reliable, specific and sensitive assay of the antibody. Clinical and imaging features of MOG-associated syndromes overlap with AQP4 antibody NMOSD but can be usually distinguished from MS: in particular, the silent lesions typical of MS that progressively increase lesion volume are rare in MOG antibody disease. The disease can relapse but medium-term immunosuppression appears to be protective. Permanent disability, particularly severe ambulatory and visual disability, is less frequent than in AQP4 antibody NMOSD and usually results from the onset attack. However, sphincter and sexual dysfunction after a transverse myelitis is common. Here we review the practical aspects of diagnosing and managing a patient with MOG antibody-associated disease.

Clinical Course, Imaging Characteristics, and Therapeutic Response in Myelin Oligodendrocyte Glycoprotein Antibody Disease: A Case Series

“…The classical MRI lesions seen in MOG antibody disease include longitudinally extensive transverse myelitis with involvement of conus medullaris, deep gray matter involvement, large bilateral asymmetric white matter lesions, extensive bilateral anterior optic nerve involvement with swelling of intraorbital segment, and fluffy brainstem lesions in the pons, medullar, or cerebellar peduncles. 12 Even though both our cases of transverse myelitis had lesions in the conus medullaris, the brain MRI findings in our series were not classical of MOG-antibody disease.…”

Recurrent visual loss in a 64-year-old man

“…Repeating serum testing for MOG-antibody at least 6 months after the initial attack may help to guide management, as patients in whom antibodies become undetectable are less likely to relapse. Long-term preventative treatments are typically considered in patients with persistent anti-MOG antibodies beyond 6 months or in patients with clinically relapsing disease 4. The decision regarding preventative treatment in this patient was difficult and highlights the current lack of predictive markers for long-term outcomes in this disease.…”

“…MOG-antibody disease follows a monophasic course in around half of patients, and a relapsing course in the other half 4. The extent of residual disability after an attack varies, and even patients with good recovery from initial attacks of optic neuritis may become visually impaired with subsequent attacks 2.…”

First Clinical Experience with Anti-myelin Oligodendrocyte Glycoprotein Antibody-Positive Optic Neuritis

“…Accordingly, antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have been consistently found in a range of inflammatory demyelinating disorders (IDDs) and focal cortical disease [4 -6]. Jurynczyk et al classified the distribution of onset presentation of MOG-IgG-positive patients in this disease spectrum [5]. They found positive antibodies in 31 % of unilateral optic neuritis (ON), 24 % in bilateral ON, 18 % in acute disseminated encephalomyelitis (ADEM), 18 % in acute transverse myelitis (ATM), and 9 % in ON and ATM [5].…”

“…Jurynczyk et al classified the distribution of onset presentation of MOG-IgG-positive patients in this disease spectrum [5]. They found positive antibodies in 31 % of unilateral optic neuritis (ON), 24 % in bilateral ON, 18 % in acute disseminated encephalomyelitis (ADEM), 18 % in acute transverse myelitis (ATM), and 9 % in ON and ATM [5]. However, no specific radiological or clinical finding that would typically characterize MOG-IgG-positive patients has been identified yet.…”