MOG-IgG in NMO and related disorders: a multicenter study of 50 patients. Part 4: Afferent visual system damage after optic neuritis in MOG-IgG-seropositive versus AQP4-IgG-seropositive patients

Abstract

BackgroundAntibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have been reported in patients with aquaporin-4 antibody (AQP4-IgG)-negative neuromyelitis optica spectrum disorders (NMOSD). The objective of this study was to describe optic neuritis (ON)-induced neuro-axonal damage in the retina of MOG-IgG-positive patients in comparison with AQP4-IgG-positive NMOSD patients.MethodsAfferent visual system damage following ON was bilaterally assessed in 16 MOG-IgG-positive patients with a history of ON and compared with that in 16 AQP4-IgG-positive NMOSD patients. In addition, 16 healthy controls matched for age, sex, and disease duration were analyzed. Study data included ON history, retinal optical coherence tomography, visual acuity, and visual evoked potentials.ResultsEight MOG-IgG-positive patients had a previous diagnosis of AQP4-IgG-negative NMOSD with ON and myelitis, and eight of (mainly recurrent) ON. Twenty-nine of the 32 eyes of the MOG-IgG-positive patients had been affected by at least one episode of ON. Peripapillary retinal nerve fiber layer thickness (pRNFL) and ganglion cell and inner plexiform layer volume (GCIP) were significantly reduced in ON eyes of MOG-IgG-positive patients (pRNFL = 59 ± 23 μm; GCIP = 1.50 ± 0.34 mm3) compared with healthy controls (pRNFL = 99 ± 6 μm, p < 0.001; GCIP = 1.97 ± 0.11 mm3, p < 0.001). Visual acuity was impaired in eyes after ON in MOG-IgG-positive patients (0.35 ± 0.88 logMAR). There were no significant differences in any structural or functional visual parameters between MOG-IgG-positive and AQP4-IgG-positive patients (pRNFL: 59 ± 21 μm; GCIP: 1.41 ± 0.27 mm3; Visual acuity = 0.72 ± 1.09 logMAR). Importantly, MOG-IgG-positive patients had a significantly higher annual ON relapse rate than AQP4-IgG-positive patients (median 0.69 vs. 0.29 attacks/year, p = 0.004), meaning that on average a single ON episode caused less damage in MOG-IgG-positive than in AQP4-IgG-positive patients. pRNFL and GCIP loss correlated with the number of ON episodes in MOG-IgG-positive patients (p < 0.001), but not in AQP4-IgG-positive patients.ConclusionsRetinal neuro-axonal damage and visual impairment after ON in MOG-IgG-positive patients are as severe as in AQP4-IgG-positive NMOSD patients. In MOG-IgG-positive patients, damage accrual may be driven by higher relapse rates, whereas AQP4-IgG-positive patients showed fewer but more severe episodes of ON. Given the marked damage in some of our MOG-IgG-positive patients, early diagnosis and timely initiation and close monitoring of immunosuppressive therapy are important.Electronic supplementary materialThe online version of this article (doi:10.1186/s12974-016-0720-6) contains supplementary material, which is available to authorized users.

Clinical features of demyelinating optic neuritis with seropositive myelin oligodendrocyte glycoprotein antibody in Chinese patients

“…However, previous reports indicated that most of the MOG-Ab-positive patients presented as monophasic disease or had less relapsing rate,8 9 which was different from the current study demonstrating both patients with MOG-ON and AQP4-ON had high recurrent episodes. However, in some other studies, patients with MOG-ON were frequently associated with a recurrent disease course 14. This study indicated that Chinese patients with MOG-ON might also have a high tendency to relapse, so that long-term immunotherapy should be considered in relapsing patients with MOG-ON.…”

“…In our previous study, the BCVA in AQP4-Ab-negative ON eyes was better than AQP4-Ab-positive ON eyes 28. In NEMOS of Caucasian descent,14 the patients’ VA was less impaired in the MOG-ON subgroup than in the AQP4-ON subgroup after more than 3 months follow-up, but the difference was not significant. The results from our Chinese cohort showed that the onset episode severity of patients with MOG-ON was similar to AQP4-ON ones but had a better visual recovery for the former group of patients.…”

“…One study of Chinese patients with CNS IDD found that ON was the most frequent clinical presentation at onset (75.0%) or during the whole disease course (83.3%) in MOG-Ab-associated IDDs 13. Some previous studies involving patients with NMO spectrum disorders (NMOSD)14 observed retinal neuroaxonal damage in MOG-Ab-positive patients, with or without ON.…”

Time to steroid treatment in severe acute optic neuritis

“…In addition, no patients were seropositive for anti‐aquaporin‐4 antibodies, but both studies identified antibodies to myelin oligodendrocyte glycoprotein (MOG) in one patient with recurrent/bilateral ON (RON/BON) (Soelberg et al., 2017). The presence of anti‐MOG antibodies in patients with RON/BON is also in accordance with other studies (Chalmoukou et al., 2015; Pache et al., 2016). …”

Diffusion tensor imaging for multilevel assessment of the visual pathway: possibilities for personalized outcome prediction in autoimmune disorders of the central nervous system

“…The discovery and investigation of aquaporin-4 (AQP4)-antibodies [21,[31][32][33][34][35] have revolutionized NMOSD diagnostics by setting the disease apart from MS [36,37] and substantially changing NMOSD treatment [38] which considerably differs from classic diseasemodifying treatment in MS [39][40][41][42][43][44][45][46][47][48]. However, especially against the background of emerging evidence on myelin oligodendrocyte glycoprotein (MOG) -antibody-positive cases related to NMOSD, the heterogeneous pathophysiology of NMOSD still needs to be fully elucidated [49][50][51][52][53][54][55][56][57][58].…”