Neurological Spectrum Disorders Associated with Anti–MOG Antibody

Abstract

Optic neuritis (ON) is an inflammatory disease of the optic nerve characterized by pain and visual lossand often associated with multiple sclerosis (MS) or neuromyelitis optica spectrum disorders (NMOSD).Autoantibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have been reported in patientswith inflammatory central nervous system disorders including isolated optic neuritis (ON).Objective: To investigate the differences of clinical features, cerebrospinal fluid (CSF), MRI findings andresponse to steroid therapies between patients with optic neuritis (ON) who have myelin oligodendrocyteglycoprotein (MOG) antibodies and seronegative group. This study was done in a period between June2015 and July 2018, 65 patients were included in this study with ON who ophthalmologists had diagnosedas having or suspected to have ON with acute visual impairment and declined critical flicker frequency,abnormal findings of brain MRI, optical coherence tomography and fluorescein fundus angiography at theironset or recurrence. After exclusion of all patients who fulfilled the diagnostic criteria of neuromyelitisoptica (NMO)/NMO spectrum disorders (NMOSD), MS McDonald’s criteria, we defined 40 patients withidiopathic ON (12 males, 28 females, age range 15-60 years). Sera from patients were tested for antibodiesto MOG and aquaporin-4 (AQP4) with a cell-based assay.Results: 37.5% (15/40) were positive for MOG antibodies, 2.5% (1/40) were positive for AQP4 and 25(62.5%) were seronegative. Among the 15 patients with MOG antibodies, four had optic pain (p=0.007) andfive had prodromal infection (p=0.05). Two of the 15 MOG-positive patients showed significantly high CSFlevels of myelin basic protein (p=0.05) and none were positive for oligoclonal band in CSF. On MRIs, fiveMOG-positive patients showed high signal intensity on optic nerve, four had a cerebral lesion and two had aspinal cord lesion. Six of the eight MOG-positive patients had a good response to steroid therapy.Conclusions: The present results indicate that Patients with NMOSD and MOG positive antibodies havedistinct clinical features, fewer attacks and better recovery than seronegative patients.