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Myelin Oligodendrocyte Glycoprotein Antibody-Positive Optic Neuritis: Clinical Characteristics, Radiologic Clues, and Outcome.
Am J Ophthalmol. 2018 11; 195:8-15.AJ

Abstract

PURPOSE

To characterize the clinical phenotype of myelin oligodendrocyte glycoprotein antibody (MOG-IgG) optic neuritis.

DESIGN

Observational case series.

METHODS

Setting: Multicenter. Patient/Study Population: Subjects meeting inclusion criteria: (1) history of optic neuritis; (2) seropositivity (MOG-IgG binding index > 2.5); 87 MOG-IgG-seropositive patients with optic neuritis were included (Mayo Clinic, 76; other medical centers, 11). MOG-IgG was detected using full-length MOG-transfected live HEK293 cells in a clinically validated flow cytometry assay.

MAIN OUTCOME MEASURES

Clinical and radiologic characteristics and visual outcomes.

RESULTS

Fifty-seven percent were female and median age at onset was 31 (range 2-79) years. Median number of optic neuritis attacks was 3 (range 1-8), median follow-up 2.9 years (range 0.5-24 years), and annualized relapse rate 0.8. Average visual acuity (VA) at nadir of worst attack was count fingers. Average final VA was 20/30; for 5 patients (6%) it was ≤20/200 in either eye. Optic disc edema and pain each occurred in 86% of patients. Magnetic resonance imaging showed perineural enhancement in 50% and longitudinally extensive involvement in 80%. Twenty-six patients (30%) had recurrent optic neuritis without other neurologic symptoms, 10 (12%) had single optic neuritis, 14 (16%) had chronic relapsing inflammatory optic neuropathy, and 36 (41%) had optic neuritis with other neurologic symptoms (most neuromyelitis optica spectrum disorder-like phenotype or acute disseminated encephalomyelitis). Only 1 patient was diagnosed with MS (MOG-IgG-binding index 2.8; normal range ≤ 2.5). Persistent MOG-IgG seropositivity occurred in 61 of 62 (98%). A total of 61% received long-term immunosuppressant therapy.

CONCLUSIONS

Manifestations of MOG-IgG-positive optic neuritis are diverse. Despite recurrent attacks with severe vision loss, the majority of patients have significant recovery and retain functional vision long-term.

Authors+Show Affiliations

Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA; Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: Chen.john@mayo.edu.Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA; Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA.Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA.Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA; Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA.Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA; Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA.Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA; Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA; Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA.Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA; Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA.Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA; Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA.Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA; Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA.Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA; Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA.Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA.Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA.Departments of Neurology and Ophthalmology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.Departments of Neurology and Ophthalmology, University of Colorado Denver School of Medicine, Aurora, Colorado, USA.Department of Ophthalmology, Neurology and Neurosurgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.Departments of Ophthalmology and Visual Sciences and Neurology, Washington University, St. Louis School of Medicine, St. Louis, Missouri, USA.Departments of Ophthalmology and Visual Science and Neurology, McGovern Medical School, Houston, Texas, USA.Departments of Neurology and Neuro-Ophthalmology Mayo Clinic, Jacksonville, Florida, USA.Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona, USA.Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA.Departments of Neurology and Neuro-Ophthalmology Mayo Clinic, Jacksonville, Florida, USA.Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA.Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA; Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30055153

Citation

Chen, John J., et al. "Myelin Oligodendrocyte Glycoprotein Antibody-Positive Optic Neuritis: Clinical Characteristics, Radiologic Clues, and Outcome." American Journal of Ophthalmology, vol. 195, 2018, pp. 8-15.
Chen JJ, Flanagan EP, Jitprapaikulsan J, et al. Myelin Oligodendrocyte Glycoprotein Antibody-Positive Optic Neuritis: Clinical Characteristics, Radiologic Clues, and Outcome. Am J Ophthalmol. 2018;195:8-15.
Chen, J. J., Flanagan, E. P., Jitprapaikulsan, J., López-Chiriboga, A. S. S., Fryer, J. P., Leavitt, J. A., Weinshenker, B. G., McKeon, A., Tillema, J. M., Lennon, V. A., Tobin, W. O., Keegan, B. M., Lucchinetti, C. F., Kantarci, O. H., McClelland, C. M., Lee, M. S., Bennett, J. L., Pelak, V. S., Chen, Y., ... Pittock, S. J. (2018). Myelin Oligodendrocyte Glycoprotein Antibody-Positive Optic Neuritis: Clinical Characteristics, Radiologic Clues, and Outcome. American Journal of Ophthalmology, 195, 8-15. https://doi.org/10.1016/j.ajo.2018.07.020
Chen JJ, et al. Myelin Oligodendrocyte Glycoprotein Antibody-Positive Optic Neuritis: Clinical Characteristics, Radiologic Clues, and Outcome. Am J Ophthalmol. 2018;195:8-15. PubMed PMID: 30055153.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Myelin Oligodendrocyte Glycoprotein Antibody-Positive Optic Neuritis: Clinical Characteristics, Radiologic Clues, and Outcome. AU - Chen,John J, AU - Flanagan,Eoin P, AU - Jitprapaikulsan,Jiraporn, AU - López-Chiriboga,Alfonso Sebastian S, AU - Fryer,James P, AU - Leavitt,Jacqueline A, AU - Weinshenker,Brian G, AU - McKeon,Andrew, AU - Tillema,Jan-Mendelt, AU - Lennon,Vanda A, AU - Tobin,W Oliver, AU - Keegan,B Mark, AU - Lucchinetti,Claudia F, AU - Kantarci,Orhun H, AU - McClelland,Collin M, AU - Lee,Michael S, AU - Bennett,Jeffrey L, AU - Pelak,Victoria S, AU - Chen,Yanjun, AU - VanStavern,Gregory, AU - Adesina,Ore-Ofe O, AU - Eggenberger,Eric R, AU - Acierno,Marie D, AU - Wingerchuk,Dean M, AU - Brazis,Paul W, AU - Sagen,Jessica, AU - Pittock,Sean J, Y1 - 2018/07/26/ PY - 2018/03/21/received PY - 2018/06/25/revised PY - 2018/07/18/accepted PY - 2018/7/29/pubmed PY - 2019/9/4/medline PY - 2018/7/29/entrez SP - 8 EP - 15 JF - American journal of ophthalmology JO - Am. J. Ophthalmol. VL - 195 N2 - PURPOSE: To characterize the clinical phenotype of myelin oligodendrocyte glycoprotein antibody (MOG-IgG) optic neuritis. DESIGN: Observational case series. METHODS: Setting: Multicenter. Patient/Study Population: Subjects meeting inclusion criteria: (1) history of optic neuritis; (2) seropositivity (MOG-IgG binding index > 2.5); 87 MOG-IgG-seropositive patients with optic neuritis were included (Mayo Clinic, 76; other medical centers, 11). MOG-IgG was detected using full-length MOG-transfected live HEK293 cells in a clinically validated flow cytometry assay. MAIN OUTCOME MEASURES: Clinical and radiologic characteristics and visual outcomes. RESULTS: Fifty-seven percent were female and median age at onset was 31 (range 2-79) years. Median number of optic neuritis attacks was 3 (range 1-8), median follow-up 2.9 years (range 0.5-24 years), and annualized relapse rate 0.8. Average visual acuity (VA) at nadir of worst attack was count fingers. Average final VA was 20/30; for 5 patients (6%) it was ≤20/200 in either eye. Optic disc edema and pain each occurred in 86% of patients. Magnetic resonance imaging showed perineural enhancement in 50% and longitudinally extensive involvement in 80%. Twenty-six patients (30%) had recurrent optic neuritis without other neurologic symptoms, 10 (12%) had single optic neuritis, 14 (16%) had chronic relapsing inflammatory optic neuropathy, and 36 (41%) had optic neuritis with other neurologic symptoms (most neuromyelitis optica spectrum disorder-like phenotype or acute disseminated encephalomyelitis). Only 1 patient was diagnosed with MS (MOG-IgG-binding index 2.8; normal range ≤ 2.5). Persistent MOG-IgG seropositivity occurred in 61 of 62 (98%). A total of 61% received long-term immunosuppressant therapy. CONCLUSIONS: Manifestations of MOG-IgG-positive optic neuritis are diverse. Despite recurrent attacks with severe vision loss, the majority of patients have significant recovery and retain functional vision long-term. SN - 1879-1891 UR - https://www.unboundmedicine.com/medline/citation/30055153/Myelin_Oligodendrocyte_Glycoprotein_Antibody_Positive_Optic_Neuritis:_Clinical_Characteristics_Radiologic_Clues_and_Outcome_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9394(18)30401-X DB - PRIME DP - Unbound Medicine ER -