Practical recognition tools of immunoglobulin G serum antibodies against the myelin oligodendrocyte glycoprotein‐positive optic neuritis and its clinical implications

Abstract

Myelin oligodendrocyte glycoprotein (MOG)‐associated disease is an autoimmune disease of the central nervous system, associated with the presence of immunoglobulin G serum antibodies against MOG. Recent data have allowed characterization of the clinical spectrum of MOG‐associated disease, which is now considered a new disease entity, distinct from multiple sclerosis and neuromyelitis optica spectrum disorders. Optic neuritis is the most common clinical presentation of MOG‐associated disease in adults, both at disease onset and during the disease course, and has several distinct clinical and paraclinical features. Immunoglobulin G serum antibodies against MOG‐positive optic neuritis is often bilateral and associated with optic disc swelling and a longitudinally extensive abnormal magnetic resonance imaging signal involving the retrobulbar portion of the optic nerve. The visual acuity during the acute attack is severely decreased, and the response to corticosteroids is often rapid and prominent. However, early relapses after steroid cessation are common, and a subset of patients is left with a permanent visual disability. In this review, we discuss the clinical and paraclinical features of immunoglobulin G serum antibodies against MOG‐positive optic neuritis in adults, and focus on the distinctive features that can enable its early diagnosis. Therapeutical considerations at the acute stage and for relapse prevention are further deliberated.

Delimiting MOGAD as a disease entity using translational imaging

“…Optic neuritis (ON) is the most frequent onset feature in adults and one of the most common manifestations of MOGAD in general ( 88 ). Thus, imaging of the visual system is a promising approach for diagnosis and differential diagnosis ( 89 , 90 ).…”

Neuro-ophthalmological Presentation of Optic Neuritis in Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

“…Acute ON in MOGAD often involves the anterior optic nerve, leading to retrobulbar optic nerve swelling 33 , 34 . Therefore, fundus examination of patients with acute MOGAD-ON frequently reveals optic disc edema, and sometimes with hemorrhages.…”

Recent advances in the understanding of myelin oligodendrocyte glycoprotein antibody–associated disorders

“…Previously, patients with such recurrences were diagnosed with pediatric multiple sclerosis; however, these are currently recognized as part of the typical symptomatic course of anti‐MOG antibody–associated disorders. In adults, optic neuritis is more frequent, and about half of the patients with this condition, previously called idiopathic optic neuritis or idiopathic retrobulbar optic neuritis, are positive for anti‐MOG antibodies 2 . Optic neuritis is often accompanied by severe eye pain and can lead to blindness within a few days; nevertheless, it responds well to steroid treatment, and in most patients, vision is restored.…”

“…In adults, optic neuritis is more frequent, and about half of the patients with this condition, previously called idiopathic optic neuritis or idiopathic retrobulbar optic neuritis, are positive for anti-MOG antibodies. 2 Optic neuritis is often accompanied by severe eye pain and can lead to blindness within a few days; nevertheless, it responds well to steroid treatment, and in most patients, vision is restored. Encephalitis and myelitis may also occur, often with urinary retention.…”