![]() Histopathology and clinical course of MOG-antibody-associated-encephalomyelitis. Failure of alemtuzumab therapy to control MOG encephalomyelitis. Myelin oligodendrocyte glycoprotein antibodies: How clinically useful are they? Curr Opin Neurol (2017) 30: 295-301ĩ. Anti-MOG antibody: The history, clinical phenotype and pathogenicity of a serum biomarker for demyelination. Distinction between MOG antibody positive and AQP4 antibody positive NMO spectrum disorders. Sato DK, Callegaro D, Lana-Peixoto MA et al. Part 4: Afferent visual system damage after optic neuritis in MOG IgG seropositive versus AQP4 IgG seropositive patients. MOG IgG in NMO and related disorders: a multicentre study of 50 patients. Part 3: Brainstem involvement frequency, progression and outcome. Part 2: Epidemiology, clinical presentation, radiological and laboratory features, treatment responses and long-term outcome. Part 1: Frequency, syndrome specificity, influence of disease activity, long term course, association with AQP4-IgG and origin. Myelin Oligodendrocyte Glycoprotein: Deciphering a target in demyelinating diseases. Peschl P, Bradl M, Hoftberger R, Beyer T, Reindl M. This is very rare and should prompt re-testing for both antibodiesĬlinical or paraclinical findings suggesting diagnoses other than MOG-EM, NMOSD or MSĬombined central and peripheral demyelination (MOG is not expressed in the peripheral nervous system)ġ. MOG IgG detected in CSF but not serum (MOG IgG is typically produced extrathecally)ĭouble positive AQP4 and MOG IgG. MOG IgG at or just barely above the assay specific cut-off, especially, but not exclusively, if the clinical picture is atypical Lesion that is adjacent to a lateral ventricle that is ovoid/round or associated with a temporal lobe lesionĪctive brain MRI over time with silent increase in lesion burden between relapses Sudden onset of symptoms (<4 h from onset to maximum)Ĭontinuous worsening of symptoms over weeks The same authors additionally defined a group of 'red flags' to challenge the authenticity of a positive MOG antibody test as defined in the following Table Seropositive MOG IgG as detected by a cell-based assay employing full - length human MOG as the target antigen. MRI findings compatible with CNS demyelinationģ. Monophasic or relapsing acute ON, myelitis, brainstem encephalitis, or encephalitis or, any in combination.Ģ. In response to this, a group of authors recently published the following criteria for a diagnosis of MOG-EM (all to be met):ġ. World-wide, there has been increasingly widespread testing of unselected populations for MOG antibodies which, even in assays that have very good performance characteristics will ultimately undermine their NPV's and PPV's which will lead to false positive reporting. Persistent MOG autoantibodies are rare but have been reported in multiphasic ADEM and they appear to be associated with active progressive disease. In the monophasic disease setting, resolution of symptoms correlated with disappearance of MOG antibody. Up to 40% of paediatric patients with inflammatory demyelinating diseases of the CNS are seropositive for MOG antibodies at the disease onset. Typically ADEM in the paediatric population follows a monophasic course with an overall favourable long-term prognosis with early intervention by way of steroid treatment and / or plasmapheresis. Location of old lesions by MRI points towards MS as opposed to ADEM since MS can cause brain lesions before symptoms become obvious. In addition, ADEM usually consists of a single episode / attack of widespread myelin damage whereas MS features may attacks over time. Impairment of consciousness (coma in some cases)Ĭhildren, (usually <10 years of age) are more likely to have ADEM than adults and MS is rare in children. History of recent infection or immunisationģ. However, the following features differentiate it from MS:Ģ. It can be mis-diagnosed as the first attack of MS since symptoms and brain white matter damage on imaging are similar. Alternatively, the on-line request form may be used.ģ mL Paediatric 3xMicro-SST Serum (Always Required)ĪDEM is characterised by a brief but widespread demyelination in the brain and spinal column. Test performed by: LabPLUS Virology/ImmunologyĪll requests must have either consultant Neurologist or Ophthalmologist approval and be documented to that effect on the request form. Myelin Oligodendrocyte Glycoprotein antibodies
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