MOG antibody seropositive aseptic meningitis: A new clinical phenotype

Nagabushana, Divya; Shah, Rutul; Pendharkar, Hima; Agrawal, Aakash; Kulkarni, Girish Baburao; Rajendran, Srijithesh; Alladi, Suvarna; Mahadevan, Anita

doi:10.1016/j.jneuroim.2019.05.001

Cited by 38 publications

(23 citation statements)

References 15 publications

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“…Unlike the previous study of patients with encephalitis other than ADEM (16) who had worse outcomes, patients with these phenotypes in our cohort all became MOG-ab seronegative and reached full recovery at last follow-up despite the relapsing course. These patients may have another autoantibody as a causative agent that accounts for additional demyelinating features (9,10). A study of seronegative patients who had MOG-abs in CSF identified no common characteristics in those patients except for the absence of isolated ON (25).…”

Section: Discussionmentioning

confidence: 99%

“…MOGantibody-associated disorders (MOGAD) are identified as entities with either different nosological, treatment response, or prognostic parameters (6)(7)(8), and no extant IDD covering all its manifestations according to current criteria or terminology. In recent years, numerous studies have found that the MOG antibody (MOG-ab) was associated with some rare and atypical demyelination types, which may expand the spectrum of MOGAD, such as unilateral cerebral cortical encephalitis (9) and meningitis (10).…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Prognostic Analysis of Autoantibody-Associated CNS Demyelinating Disorders in Children in Southwest China

Sun

Fan

et al. 2021

Front. Neurol.

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Objective: To analyze the positive and recurrence rates of different autoantibody-associated demyelination disorders in children in Southwest China, and describe the clinical, radiological, and prognostic features of the myelin oligodendrocyte glycoprotein antibody (MOG-ab) and aquaporin-4 antibody (AQP4-ab) associated disease. This study also summarizes steroid maintenance therapy approaches for MOG-ab-positive children.Methods: A total of 160 children presenting with acquired demyelinating syndromes (ADS) between January 2016 and December 2019 were tested for MOG-ab and AQP4-ab. Clinical data, MRI scans, and survival analyses were compared between MOG-ab-positive and AQP4-ab-positive children. Evolution of serologic status and treatment response to immunosuppressants were collected in MOG-ab-positive children.Results: Of the 160 included children, the MOG-ab positivity rate (47.4%) was significantly higher than the AQP4-ab (5%) positivity rate. The recurrence rate for AQP4-ab disease (71.4%) was higher than that of MOG-ab disease (30.1%). For 135 children with both MOG-ab and AQP4-ab tested, the median age at onset was 7 (interquartile range [IQR] 5–10) years, and the median follow-up period was 19 (IQR 13–27.5) months. MOG-ab-positive children more frequently presented with acute disseminated encephalomyelitis, had deep gray matter lesions on MRI, had a better clinical and radiological recovery, and were less likely to have sustained disability than AQP4-ab-positive children. In MOG-ab-positive and AQP4-ab-positive children, maintenance therapy was a protective factor for recurrence, but presenting optic neuritis was a predictor of earlier relapse. A high Expanded Disability Status Scale score at onset was associated with sustained disability. Steroid maintenance therapy longer than 6 months after the initial attack was associated with a lower risk of a second relapse in MOG-ab-positive children. On serial serum MOG antibody analysis, clinical relapse occurred in 34.6% of children with persistent seropositivity, but none of the children who converted to seronegative status experienced relapse.Conclusion: The MOG antibody is more common in children with ADS than the AQP4 antibody. MOG-ab-positive children are characterized by distinct clinical and radiological features. Although some MOG-ab-positive children experience relapsing courses or have persistently seropositive status, they still predict a better outcome than AQP4-ab-positive children.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and Prognostic Analysis of Autoantibody-Associated CNS Demyelinating Disorders in Children in Southwest China

Sun

Fan

et al. 2021

Front. Neurol.

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“…Leptomeningeal enhancement can occur in MOG antibody–associated disorder, including spinal leptomeningeal enhancement, 6 and aseptic meningitis with demyelinating lesions. 7,8 MOG antibodies are more likely to occur in children as compared to adults. 1 Moreover, phenotypic presentations are different as children are more likely to present with encephalopathy or acute disseminated encephalomyelitis, whereas adults are more likely to have optic neuritis-myelitis.…”

Section: Discussionmentioning

confidence: 99%

Rate of Leptomeningeal Enhancement in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody–Associated Encephalomyelitis

et al. 2021

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Introduction: Myelin oligodendrocyte glycoprotein antibodies (MOG-abs) are associated with demyelinating diseases. Leptomeningeal enhancement occurs in 6% of adult MOG-abs patients but rates in pediatric MOG-abs patients are unknown. Methods: Retrospective review of pediatric MOG-abs patients was performed. Results: Twenty-one patients (7 boys, 14 girls) were included with an average age of 8.6 years (range 2-15 years). Seven of 21 (33%) pediatric MOG-abs patients had leptomeningeal enhancement. Two patients’ relapses were manifested by leptomeningeal enhancement alone and another patient presented with seizures, encephalopathy, and aseptic meningitis without demyelinating lesions. Cerebrospinal fluid pleocytosis was seen in both leptomeningeal (4/7 patients) and nonleptomeningeal enhancement (10/14 patients). Interestingly, 3 patients with leptomeningeal enhancement had normal cerebrospinal fluid white blood cell count. Cortical edema was more likely in patients with leptomeningeal enhancement ( P = .0263). Conclusion: We expand the clinical spectrum of anti-MOG antibody–associated disorder. Patients with recurrent leptomeningeal enhancement without demyelinating lesions should be tested for MOG antibodies.

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“…MOGAD is an autoimmune in ammatory CNS demyelinating syndrome which presents as optic neuritis, myelitis, encephalitis and acute disseminated encephalomyelitis (ADEM) 20,22 35 . Meningitis and cortical encephalitis have been seldomly reported [36][37][38][39] . In Jarius's study 40 , Brainstem involvement is present in around one third of MOG-IgG-positive patients with ON and/or myelitis.…”

Section: Discussionmentioning

confidence: 99%

MOG Antibody Positive Optic Perineuritis: an Observational Study in Han Chinese

Meng¹,

Wang²,

Liu³

et al. 2021

Preprint

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ObjectiveTo shed light on the clinical characteristics, magnet resonance imaging(MRI) changes, and prognosis of myelin oligodendrocyte glycoprotein antibody (MOG-IgG) positive OPN in Han Chinese.MethodsWe observed 39 MOG-IgG positive patients in our ward from January 1, 2017 , to December 31, 2019. Twenty patients met OPN inclusion criteria included contrast enhancement surrounding the optic nerve, and at least one of the following clinical symptoms: 1) reduction of visual acuity, 2) impairment of visual field, and 3) eye pain. Single course group(n=11) and recurrence group(n=9) were used for comparison. Outcome variables included Wingerchuk visual acuity classification.Results Of the 20 patients with MOG-IgG positive OPN, 12(60%) were women. Ten cases (50%) presented with bilateral and 17 eyes (56.67%) with severe visual loss (SVL,≤ 0.1). Twenty-one(70.00%) eyes showed edema of optic disc. Twenty-five eyes (83.3%) had longitudinally extensive perineural enhancement. At follow-up, 4 (13%) eyes still had SVL, while 26 (87%) eyes had no SVL, and of the 19 ON patients, 3 (9%) eyes still had SVL. Seven patients (35.00%) experienced at least a relapse(median interval 13.5 months ), and of the 19 ON cases, 4 (21%) patients experienced relapse. The relapse occurred more often in younger patients than the older (mean year: 38.00 vs. 45.54 years; P = 0.025). There were no optic chiasm and brainstem lesions.ConclusionsMOG-IgG positive OPN in Han Chinese often causes severe bilateral visual loss and longitudinally extensive perineural lesion. Younger patients are more likely to relapse. Optic chiasm and brainstem lesions were relatively rare.

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MOG antibody seropositive aseptic meningitis: A new clinical phenotype

Cited by 38 publications

References 15 publications

Clinical and Prognostic Analysis of Autoantibody-Associated CNS Demyelinating Disorders in Children in Southwest China

Clinical and Prognostic Analysis of Autoantibody-Associated CNS Demyelinating Disorders in Children in Southwest China

Rate of Leptomeningeal Enhancement in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody–Associated Encephalomyelitis

MOG Antibody Positive Optic Perineuritis: an Observational Study in Han Chinese

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