Myelin Oligodendrocyte Glycoprotein and Neuromyelitis Optica/Aquaporin-4 Antibody Negative COVID-19–Associated Optic Neuritis

Neuromyelitis optica (NMO) has been traditionally described as the association of recurrent or bilateral optic neuritis and longitudinally extensive transverse myelitis (LETM). Identification of aquaporin-4 antibody (AQP4-IgG) has deeply changed the concept of NMO. A spectrum of NMO disorders (NMOSD) has been formulated comprising conditions which include both AQP4-IgG seropositivity and one of the index events of the disease (recurrent or bilateral optic neuritis and LETM). Most NMO patients harbor asymptomatic brain MRI lesions, some of them considered as typical of NMO. Some patients with aquaporin-4 autoimmunity present brainstem, hypothalamic or encephalopathy symptoms either preceding an index event or occurring isolatedly with no evidence of optic nerve or spinal involvement. On the opposite way, other patients have optic neuritis or LETM in association with typical lesions of NMO on brain MRI and yet are AQP4-IgG seronegative. An expanded spectrum of NMO disorders is proposed to include these cases.

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Frequency of New Silent MRI Lesions in Myelin Oligodendrocyte Glycoprotein Antibody Disease and Aquaporin-4 Antibody Neuromyelitis Optica Spectrum Disorder

JAMA Network Open ◽

10.1001/jamanetworkopen.2021.37833 ◽

2021 ◽

Vol 4 (12) ◽

pp. e2137833

Author(s):

Valentina Camera ◽

Leah Holm-Mercer ◽

Ali Asgar Hatim Ali ◽

Silvia Messina ◽

Timotej Horvat ◽

...

Keyword(s):

Neuromyelitis Optica ◽

Myelin Oligodendrocyte Glycoprotein ◽

Spectrum Disorder ◽

Aquaporin 4 ◽

Neuromyelitis Optica Spectrum Disorder ◽

Silent Mri ◽

Aquaporin 4 Antibody

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Antibodies to myelin oligodendrocyte glycoprotein in aquaporin 4 antibody seronegative longitudinally extensive transverse myelitis: Clinical and prognostic implications

Multiple Sclerosis Journal ◽

10.1177/1352458515591071 ◽

2015 ◽

Vol 22 (3) ◽

pp. 312-319 ◽

Cited By ~ 45

Author(s):

Álvaro Cobo-Calvo ◽

María Sepúlveda ◽

Raphael Bernard-Valnet ◽

Anne Ruiz ◽

David Brassat ◽

...

Keyword(s):

Optic Neuritis ◽

Transverse Myelitis ◽

Myelin Oligodendrocyte Glycoprotein ◽

Aquaporin 4 ◽

First Episode ◽

Longitudinally Extensive Transverse Myelitis ◽

Increase Risk ◽

Cerebrospinal Fluid Pleocytosis ◽

Aquaporin 4 Antibody ◽

Extensive Transverse Myelitis

Objective: We aimed to investigate the frequency and clinical significance of antibodies to myelin oligodendrocyte glycoprotein (MOG-abs) in patients who presented with a first episode of seronegative aquaporin 4 antibody (AQP4-ab) longitudinally extensive transverse myelitis (LETM). Methods: Epidemiological, clinical, and paraclinical data of 56 patients from three European centres were analysed. Patients were retrospectively tested for MOG-abs and AQP4-abs, by cell-based assays. Findings: Thirteen (23.2%) patients were MOG-ab positive. Among the 56 patients, six (10.7%) converted to neuromyelitis optica (NMO), one (1.8%) to multiple sclerosis (MS), nine (16.1%) had recurrent LETM, and 40 (71.4%) remained as monophasic LETM. Compared with seronegative patients, those with MOG-abs were younger (median: 32.5 vs 44 years; p=0.007), had cerebrospinal fluid pleocytosis more frequently (94% vs 45%, p=0.003) and had better outcome (median Expanded Disability Status Scale (EDSS) 2.0 vs 3.0, p=0.027). MOG-ab positive patients also showed an increase risk of optic neuritis relapse and NMO conversion ( p=0.010). Conclusion: Patients with MOG-abs in AQP4-ab seronegative LETM have clinical distinctive features, higher risk of optic neuritis relapses, and better outcome than patients seronegative.

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Clinical presentation of optic neuritis with autoantibodies anti-myelin oligodendrocyte glycoprotein

European Journal of Ophthalmology ◽

10.1177/1120672118784797 ◽

2018 ◽

Vol 29 (2) ◽

pp. 257-261 ◽

Cited By ~ 4

Author(s):

Jean-Baptiste Ducloyer ◽

Laure Michel ◽

Sandrine Wiertlewski ◽

Pierre Lebranchu

Keyword(s):

Visual Acuity ◽

Standard Deviation ◽

Optic Neuritis ◽

Neuromyelitis Optica ◽

Clinical Presentation ◽

Final Diagnosis ◽

Myelin Oligodendrocyte Glycoprotein ◽

Spectrum Disorder ◽

Aquaporin 4 ◽

Neuromyelitis Optica Spectrum Disorder

Purpose: Myelin oligodendrocyte glycoprotein autoantibodies are associated with certain optic neuritis. Little data are known about the specificity of the initial ophthalmologic presentation. Methods: A monocentric retrospective study (2013–2017) of all patients diagnosed with myelin oligodendrocyte glycoprotein+ optic neuritis in a tertiary ophthalmologic unit was conducted. The primary objective was to define the clinical ophthalmologic description of the first episode. The secondary objective was to evaluate the evolution and final diagnosis. Results: A total of nine patients were included. There was no female predominance (sex ratio f/m = 0.8). At the first optic neuritis episode, the average age was 39.3 years (17–67 years, standard deviation: 18.4). Initial visual acuity was low (+1.07logMAR, standard deviation: 0.77); 5 eyes out of 15 had visual acuity +2logMAR or worse. Optic neuritis was mostly painful (8/9) and bilateral (6/9) but asymmetric. Optic disk swelling was reported in 9/15 eyes and 7/9 patients and was significantly associated with lower visual acuity in the acute phase (+1.46logMAR, standard deviation: 0.67 vs +0.5, standard deviation: 0.55; p = 0.03). After a mean observation period of 3.3 years (0.6–9.4 years, standard deviation: 3.4), median visual acuity was 0.05logMAR. All five patients were followed up for more than 1 year (5.4 years, standard deviation: 3.2) had 3–8 relapses (mean: 4.4, standard deviation: 2.1; annualized relapse rate: 1.2, standard deviation: 0.9). Final diagnosis was chronic relapsing idiopathic optic neuritis (n = 4), clinically isolated optic neuritis (n = 3), and neuromyelitis optica spectrum disorder aquaporin 4– (n = 2). Conclusion: Myelin oligodendrocyte glycoprotein+ optic neuritis has an atypical clinical presentation compared with multiple sclerosis and neuromyelitis optica spectrum disorder aquaporin 4+. Its evolution is closer to neuromyelitis optica spectrum disorder aquaporin 4+, with a better visual outcome.

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