What proportion of AQP4-IgG-negative NMO spectrum disorder patients are MOG-IgG positive? A cross sectional study of 132 patients

• Published in: Journal of neurology Vol. 264; no. 10; pp. 2088 - 2094
• Main Authors: Hamid, Shahd H. M., Whittam, Daniel, Mutch, Kerry, Linaker, Samantha, Solomon, Tom, Das, Kumar, Bhojak, Maneesh, Jacob, Anu
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2017; Springer Nature B.V
• Subjects: Adolescent; Adult; Antibodies; Aquaporin 4; Aquaporin 4 - immunology; Aquaporins; Clinical trials; Cross-Sectional Studies; Demyelinating Diseases - blood; Demyelinating Diseases - immunology; Demyelination; Female; Glycoproteins; Humans; Immunoglobulin G; Immunoglobulin G - blood; Immunosuppressive Agents - therapeutic use; Magnetic resonance imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Myelin; Myelin-Oligodendrocyte Glycoprotein - immunology; Neurology; Neuromyelitis; Neuromyelitis Optica - blood; Neuromyelitis Optica - drug therapy; Neuromyelitis Optica - epidemiology; Neuromyelitis Optica - immunology; Neuroradiology; Neurosciences; Oligodendrocyte-myelin glycoprotein; Original Communication; Patients; Young Adult; Myelin oligodendrocytes glycoprotein; Neuromyelitis optica; Aquaporin-4 antibodies
• ISSN: 0340-5354; 1432-1459
• DOI: 10.1007/s00415-017-8596-7

Antibodies to myelin oligodendrocyte glycoprotein (MOG-IgG) have been described in patients with neuromyelitis optica spectrum disorders (NMOSD) without aquaporin-4 antibodies (AQP4-IgG). We aimed to identify the proportion of AQP4-IgG-negative NMOSD patients who are seropositive for MOG-IgG. In a cross sectional study, we reviewed all patients seen in the National NMO clinic over the last 4 years (after the availability of MOG-IgG testing), including clinical information, MRI, and antibody tests. 261 unique patients were identified. 132 cases satisfied the 2015 NMOSD diagnostic criteria. Of these, 96 (73%) were AQP4-IgG positive and 36 (27%) were AQP4-IgG negative. These 36 patients were tested for MOG-IgG and 15/36 (42%) tested positive. 20% (25/125) of the patients who did not satisfy NMOSD criteria had MOG-IgG. Approximately half of seronegative NMOSD is MOG-Ig seropositive and one in five of non-NMOSD/non-MS demyelination is MOG-IgG positive. Since MOG-associated demyelinating disease is likely different from AQP4-IgG disease in terms of underlying disease mechanisms, relapse risk and possibly treatment, testing for MOG-IgG in patients with AQP4-IgG-negative NMOSD and other non-MS demyelination may have significant implications to management and clinical trials.