MOG-Ab prevalence in optic neuritis and clinical predictive factors for diagnosis

Abstract

ObjectiveWhat is the proportion of antibodies to myelin oligodendrocyte glycoprotein (MOG-Ab) in optic neuritis (ON) in adults and what would be the ON presentation for which MOG-Ab should be tested?MethodsMulticentric prospective study conducted during 1 year on all patients diagnosed with acute ON in all ophthalmological units in hospitals in a region in western France.ResultsSixty-five patients were included. MOG-Ab prevalence was 14% (9/65) during an acute ON and 13% (7/55) after exclusion of patients already diagnosed with multiple sclerosis (MS) (8) or MOG+ON (2). Compared with MS and clinically isolated syndrome, MOG+ON had no female preponderance (67% of men in case of MOG+ON and 22% of men in case of MS and clinically isolated syndrome, p<0.05) were more often bilateral (44% vs 3%, p<0.005) and associated with optic disc swelling (ODS) (78% vs 14%, p<0.001). To predict MOG+ON, the positive predictive values (PPVs) of male sex, ODS and bilateral involvement were 29% (95% CI 9% to 48%), 41% (95% CI 18% to 65%) and 40% (95% CI 10% to 70%), respectively, while the negative predictive values (NPV) were 93% (95% CI 86% to 100%), 96% (95% CI 90% to 100%) and 91% (95% CI 83% to 99%), respectively. The combined factor ‘ODS or bilateral or recurrent ON’ was the best compromise between PPV (31% (95% CI 14% to 48%)) and NPV (100% (95% CI 100% to 100%)).ConclusionAmong ON episodes, MOG-Ab were found in 14% of cases. MOG+ON occurred without female preponderance and was significantly associated with ODS and/or bilateral ON. Testing MOG-Ab only in patients presenting with ODS or bilateral or recurrent ON would limit MOG-Ab tests to fewer than half of all patients without the risk of missing any MOG+ON cases.

Clinical Features and Risk of Relapse in Children and Adults with Myelin Oligodendrocyte Glycoprotein Antibody–Associated Disease

“…The participation of most of the French centers specializing in demyelinating diseases, the data collection through homogenous standards, and the inclusion of patients within the same national central database likely reflect the real relative frequency between children and adults with MOGAD in France. It is well established that whereas MOG-Ab is present in a high proportion of children with a first episode of an ADS, [5][6][7][8] positive cases are rarely found in adults, 22,23 a finding likely explained by the lower ratio of MS diagnosis in children with demyelinating diseases. Although our study was not designed to evaluate the frequency of MOG-Ab among patients starting with a first ADS, we observed herein that the frequency of MOG-Ab in adults is probably higher than previously thought, according to recent studies.…”

Frequency of myelin oligodendrocyte glycoprotein antibodies in a large cohort of neurological patients

“…In turn, recurrent often bilateral painful optic neuritis (ON) with optic nerve perineuritis and optic disc swelling as well as myelitis of the lower spinal cord are found to be indicative for MOG-AD. [13][14][15][16][17] By using enzyme linked immunosorbent assay (ELISA) and Westernblot (WB) as detection methods, MOG-Ab have been found in patients with other neurological disorders including multiple sclerosis, stroke and polyneuropathy as well as in viral (HSV, EBV) or autoimmune encephalitis (anti-NMDAR) several years ago. 10,12,[18][19][20][21][22] To date, detection of MOG-Ab by ELISA, WB or fixed cell-based assay are known to be less specific.…”

“…In turn, recurrent often bilateral painful optic neuritis (ON) with optic nerve perineuritis and optic disc swelling as well as myelitis of the lower spinal cord are found to be indicative for MOG-AD. 13 – 17 …”

Clinical Features and Imaging Findings of Myelin Oligodendrocyte Glycoprotein-IgG-Associated Disorder (MOGAD)

“…Rempe 's study showed that compared with NMOSD patients, MOGAD patients with ON were more prone to bilateral optic nerve involvement (6/11 [54.5%] vs. 6/43 [13.9%]; p = 0.009) (Rempe et al, 2021). Some scholars have concluded that the anterior optic nerve is significantly more likely to be involved in MOGAD patients, which is different from AQP-4 antibodypositive patients (Kitley et al, 2014;Ducloyer et al, 2020). As we searched, it became clear that MOGAD patients usually have longitudinally bilateral optic nerve swelling, and abnormal signals around sheath or adipose tissue were occasionally found on imaging (Deneve et al, 2019;Ducloyer et al, 2020;Shor et al, 2021).…”