Myelin oligodendrocyte glycoprotein antibodies are associated with bilateral and recurrent optic neuritis and have a distinct radiological profile to multiple sclerosis or aquaporin-4 antibody-associated optic neuritis

Abstract

Objective: We performed clinical and radiological characterisation of first episode optic neuritis (ON) in patients with myelin oligodendrocyte glycoprotein antibody-associated ON(MOG-ON), aquaporin-4 antibody-associated ON(AQP4-ON), and multiple sclerosis(MS-ON). We hypothesised there would be specific radiological predictors depending on the cause of ON. Background: Early recognition of the etiology of ON affects treatment decisions and prognosis. Design/Methods: We performed a flow cytometry cell-based assay using live HEK293 cells expressing full-length human MOG to test the serum of 23 adults with AQP4 antibody-negative neuromyelitis optica spectrum disorders. Blinded neuroradiological assessment was subsequently performed on magnetic resonance imaging of fifty patients (mean age 24 years, range 3-58, 41 females) with a first episode of ON, including MOG-ON (n=19), AQP4-ON (n=11), MS-ON (n=13), and unclassified ON (n=7). Results: MOG antibodies were detected in 9/23 patients, all of whom had bilateral ON. MOG-ON patients were more likely to have a relapsing course and be steroid responsive. Bilateral involvement was more common in MOG-ON and AQP4-ON than MS-ON (84[percnt] v.82[percnt] v.23[percnt]), optic nerve head swelling was more common in MOG-ON (53[percnt] v.9[percnt] v.0[percnt]), chiasmal involvement was more common in AQP4-ON (5[percnt] v.64[percnt] v.15[percnt]), and bilateral optic tract involvement was more common in AQP4-ON (0[percnt] v.45[percnt] v.0[percnt]). Retrobulbar optic nerve involvement was more common in MOG-ON, whereas intracranial optic nerve involvement was more common in AQP4-ON. MOG-ON and AQP4-ON had longer lesion lengths and lesion extent scores than MS-ON. AQP4-ON more frequently had severe and sustained visual impairment. Conclusions: MOG antibodies are associated with a bilateral ON phenotype and are steroid responsive. MOG and AQP4-ON are frequently bilateral and longitudinally extensive, compared with MS-ON. MOG-ON tends to involve the anterior optic pathway whereas AQP4-ON tends to involve the posterior optic pathway. These radiological predictors may expedite diagnosis at the first presentation of ON, with therapeutic and prognostic implications.L722502922016-04-27 <br />