<p>MOG-IgG- versus AQP4-IgG-Positive Optic Neuritis in Thailand: Clinical Characteristics and Long-Term Visual Outcomes Comparison</p>

Abstract

Purpose: To compare demographic data, clinical and radiological characteristics, treatment, and long-term visual outcomes between myelin oligodendrocyte glycoprotein autoantibodypositive optic neuritis (MOG-IgG + ON) and aquaporin-4 autoantibody-positive optic neuritis (AQP4-IgG + ON) in Thailand. Patients and Methods: We included individuals who were diagnosed with either MOG-IgG + ON or AQP4-IgG + ON over an 11-year period. Demographic data, clinical and radiological characteristics at ON presentation, treatment, and long-term visual outcomes were retrospectively collected. Results: There were 16 patients (28 eyes) and 43 patients (59 eyes) in the MOG-IgG + ON and AQP4-IgG + ON groups, respectively. AQP4-IgG + ON occurred predominantly in female patients whereas MOG-IgG + ON-affected female patients and male patients equally (p < 0.001). Prior or concurrent non-ON demyelinating events were more often observed at AQP4-IgG + ON onset (p < 0.001). At ON presentation, bilaterality and the presence of optic disc edema were predominantly found in the MOG-IgG + ON group (bilaterality: 80% vs 8%, MOG-IgG + ON vs AQP4-IgG + ON patients, respectively (p < 0.001); presence of optic disc edema: 92.3% vs 36.6%, MOG-IgG + ON-vs AQP4-IgG + ON-affected eyes, respectively (p < 0.001)). There was no statistically significant difference in age at ON onset, nadir visual acuity (VA), presence of pain, segmental enhancement, and total enhanced segments of the anterior visual pathways. At the last follow-up, immunosuppressive drugs were used more often in the AQP4-IgG + ON group (43.7% vs 74.4%, MOG-IgG + ON vs AQP4-IgG + ON, respectively; p < 0.027). Remarkably better final VA was achieved in MOG-IgG + ON-affected eyes (median: 0.0 vs 0.4 logMAR, MOG-IgG + ON-vs AQP4-IgG + ON-affected eyes, respectively; p < 0.001). Conclusion: Compared with AQP4-IgG + ON, MOG-IgG + ON tended to present with bilaterality and optic disc edema and demonstrated better visual outcomes.

Clinical spectrum of myelin oligodendrocyte glycoprotein antibody-associated disease in Brazil: a single-center experience

“… 21 Furthermore, severe headache was reported in 75% of the ON cases and had already been described in prior reports on MOGAD. 22 23 24 Oftentimes headache preceded the onset of visual loss by some days or even weeks, was reported as intense and migraine-like, and usually responded well to steroid treatment.…”

MOG antibody-associated optic neuritis

“…Eye pain may be common in MOG-ON, reported in 73-92% of cases internationally [42,43,48,51,56,57]. In comparative studies, this proportion has been shown to be greater than in AQP4-ON (28-50%) and seronegative ON, including MS (10-46%) [48,51,58]. The majority of eye pain in MOG-ON is pain related to eye movement, with periocular pain being less common [56,57].…”

“…The presence of severe optic disc swelling and peripapillary haemorrhage in the setting of ON is highly suggestive of MOG-ON. Optic disc swelling visible on fundoscopy has been reported in 45-92% of cases of MOG-ON across various international cohorts [22,[43][44][45][47][48][49][50][51][52], and is an important diagnostic clue when assessing patients with ON. This is far more common than the frequencies reported in AQP4-ON (7-52%) [44,48,50,51], and MS-ON (11-14%) [49,51].…”

“…Optic disc swelling visible on fundoscopy has been reported in 45-92% of cases of MOG-ON across various international cohorts [22,[43][44][45][47][48][49][50][51][52], and is an important diagnostic clue when assessing patients with ON. This is far more common than the frequencies reported in AQP4-ON (7-52%) [44,48,50,51], and MS-ON (11-14%) [49,51]. Optic disc swelling is moderate to severe in many cases of MOG-ON and has been associated with peripapillary haemorrhage [43,46].…”

Long-Term Visual Prognosis in Patients With Aquaporin-4-Immunoglobulin G–Positive Neuromyelitis Optica Spectrum Disorder

“…The introduction of AQP4-IgG has improved our understanding of CNS demyelinating disease and expanded the recognition of the clinical phenotype (5). Furthermore, AQP4-IgG provides the diagnostic criteria; AQP4-IgG positivity in NMOSD implies poor visual prognosis after ON as compared with multiple sclerosis and myelin oligodendrocyte glycoprotein antibody–associated disorders (6–12).…”