TU22. SPATIOTEMPORAL MODULARITY OF GWAS GENES (STGWAS) IDENTIFIED DISTINCT EFFECT OF PRENATAL AND POSTNATAL BRAIN EXPRESSION ACROSS 20 BRAIN DISORDERS AND ANTHROPOMETRIC SOCIAL TRAITS

Abstract

To report the clinical presentation of a relapse in a patient with MOG antibody disease who had been relapse free for over 20 years.The patient was evaluated in the Providence MS Center.The patient had history of two episodes of optic neuritis in the 1990s. Although clinically stable in 2019, her serum anti-MOG titer was positive, 1:1000. Treatment was not offered since she had remained clinically stable for over 20 years. However, in February 2021 she acutely developed diplopia, right upper extremity sensory disturbance, and ataxia. MR imaging revealed enhancing lesions in the brainstem and cervical spinal cord. Repeat testing for anti-MOG antibodies was positive, 1:10,000.A high anti-MOG antibody titer, at a time when the patient was clinically stable, may have been of prognostic significance. This raises the question of whether initiating treatment solely in response to an elevated titer may have prevented her recent relapse. This case raises the question of whether prospectively monitoring anti-MOG IgG levels in clinically and radiographically stable patients is needed, and if elevated titers are present should treatment be initiated. We believe these issues warrant further prospective investigation in a larger patient cohort.