The paper describes the clinical features of patients with myelin oligodendrocyte glycoprotein antibodies (MOG-Ab), and explores the prognostic values of MOG autoimmunity. This study is important because the MOG-Ab test is relatively new, and clinicians are still trying to determine when to order it.

Study design

Researchers obtained clinical data from 197 MOG-Ab-positive adults (≥18 years). Of these, 108 patients had complete imaging data. A longitudinal evaluation was performed using 54 serum samples. For survival analysis comparison, the authors obtained data from 169 patients in the NOMADMUS database who were positive for aquaporin-4 antibody (AQP4-Ab).

Outcomes

At disease onset, about 90.9% of MOG-Ab-positive patients had optic neuritis or myelitis, while 6.6% had isolated brainstem or encephalopathy syndromes and 2.5% had a combination of syndromes. The authors noted distinctive brain MRI findings in MOG-Ab-positive patients, including thalamic and pontine lesions. About 16% of these patients had cortical lesions, while 6% had leptomeningeal lesions. The risk of clinical relapse was lower in MOG-Ab-positive than in AQP4-positive individuals.

Limitations

This study is limited by its retrospective design and the fact that not all patients were diagnosed at disease onset. Finally, MRI studies were not obtained at standardized points in time.

Clinical significance

In adults, MOG-Ab-associated disease extends beyond clinical and radiologic abnormalities in the optic nerve and spinal cord. Despite relapses, MOG-Ab-positive patients had better overall visual and motor outcomes than AQP4-Ab-positive patients.