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Clinical, Radiologic, and Prognostic Features of Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Autoantibody.
JAMA Neurol. 2019 03 01; 76(3):301-309.JN

Abstract

Importance

Recognizing the characteristics of myelin oligodendrocyte glycoprotein autoantibody (MOG-IgG) myelitis is essential for early accurate diagnosis and treatment.

Objective

To evaluate the clinical, radiologic, and prognostic features of MOG-IgG myelitis and compare with myelitis with aquaporin-4-IgG (AQP4-IgG) and multiple sclerosis (MS).

Design, Setting, and Participants

We retrospectively identified 199 MOG-IgG-positive Mayo Clinic patients from January 1, 2000, through December 31, 2017, through our neuroimmunology laboratory. Fifty-four patients met inclusion criteria of (1) clinical myelitis; (2) MOG-IgG positivity; and (3) medical records available. We excluded 145 patients without documented myelitis. Myelitis of AQP4-IgG (n = 46) and MS (n = 26) were used for comparison.

Main Outcomes and Measures

Outcome variables included modified Rankin score and need for gait aid. A neuroradiologist analyzed spine magnetic resonance imaging of patients with MOG-IgG and control patients blinded to diagnosis.

Results

Of 54 included patients with MOG-IgG myelitis, the median age was 25 years (range, 3-73 years) and 24 were women (44%). Isolated transverse myelitis was the initial manifestation in 29 patients (54%), and 10 (19%) were initially diagnosed as having viral/postviral acute flaccid myelitis. Cerebrospinal fluid-elevated oligoclonal bands occurred in 1 of 38 (3%). At final follow-up (median, 24 months; range, 2-120 months), 32 patients (59%) had developed 1 or more relapses of optic neuritis (n = 31); transverse myelitis (n = 7); or acute disseminated encephalomyelitis (n = 1). Clinical features favoring MOG-IgG myelitis vs AQP4-IgG or MS myelitis included prodromal symptoms and concurrent acute disseminated encephalomyelitis. Magnetic resonance imaging features favoring MOG-IgG over AQP4-IgG or MS myelitis were T2-signal abnormality confined to gray matter (sagittal line and axial H sign) and lack of enhancement. Longitudinally extensive T2 lesions were of similar frequency in MOG-IgG and AQP4-IgG myelitis (37 of 47 [79%] vs 28 of 34 [82%]; P = .52) but not found in MS. Multiple spinal cord lesions and conus involvement were more frequent with MOG-IgG than AQP4-IgG but not different from MS. Wheelchair dependence at myelitis nadir occurred in one-third of patients with MOG-IgG and AQP4-IgG but never with MS, although patients with MOG-IgG myelitis recovered better than those with AQP4-IgG.

Conclusions and Relevance

Myelitis is an early manifestation of MOG-IgG-related disease and may have a clinical phenotype of acute flaccid myelitis. We identified a variety of clinical and magnetic resonance imaging features that may help clinicians identify those at risk in whom MOG-IgG should be tested.

Authors+Show Affiliations

Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota. Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota. Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Radiology (Division of Neuroradiology), Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Radiology (Division of Neuroradiology), Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota. Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota. Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota. Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota.Department of Pediatrics, University of Colorado School of Medicine, Aurora.Department of Neurology, University of Colorado School of Medicine, Aurora.Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota. Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30575890

Citation

Dubey, Divyanshu, et al. "Clinical, Radiologic, and Prognostic Features of Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Autoantibody." JAMA Neurology, vol. 76, no. 3, 2019, pp. 301-309.
Dubey D, Pittock SJ, Krecke KN, et al. Clinical, Radiologic, and Prognostic Features of Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Autoantibody. JAMA Neurol. 2019;76(3):301-309.
Dubey, D., Pittock, S. J., Krecke, K. N., Morris, P. P., Sechi, E., Zalewski, N. L., Weinshenker, B. G., Shosha, E., Lucchinetti, C. F., Fryer, J. P., Lopez-Chiriboga, A. S., Chen, J. C., Jitprapaikulsan, J., McKeon, A., Gadoth, A., Keegan, B. M., Tillema, J. M., Naddaf, E., Patterson, M. C., ... Flanagan, E. P. (2019). Clinical, Radiologic, and Prognostic Features of Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Autoantibody. JAMA Neurology, 76(3), 301-309. https://doi.org/10.1001/jamaneurol.2018.4053
Dubey D, et al. Clinical, Radiologic, and Prognostic Features of Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Autoantibody. JAMA Neurol. 2019 03 1;76(3):301-309. PubMed PMID: 30575890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical, Radiologic, and Prognostic Features of Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Autoantibody. AU - Dubey,Divyanshu, AU - Pittock,Sean J, AU - Krecke,Karl N, AU - Morris,Padraig P, AU - Sechi,Elia, AU - Zalewski,Nicholas L, AU - Weinshenker,Brian G, AU - Shosha,Eslam, AU - Lucchinetti,Claudia F, AU - Fryer,James P, AU - Lopez-Chiriboga,A Sebastian, AU - Chen,John C, AU - Jitprapaikulsan,Jiraporn, AU - McKeon,Andrew, AU - Gadoth,Avi, AU - Keegan,B Mark, AU - Tillema,Jan-Mendelt, AU - Naddaf,Elie, AU - Patterson,Marc C, AU - Messacar,Kevin, AU - Tyler,Kenneth L, AU - Flanagan,Eoin P, PY - 2018/12/24/pubmed PY - 2020/2/19/medline PY - 2018/12/22/entrez SP - 301 EP - 309 JF - JAMA neurology JO - JAMA Neurol VL - 76 IS - 3 N2 - Importance: Recognizing the characteristics of myelin oligodendrocyte glycoprotein autoantibody (MOG-IgG) myelitis is essential for early accurate diagnosis and treatment. Objective: To evaluate the clinical, radiologic, and prognostic features of MOG-IgG myelitis and compare with myelitis with aquaporin-4-IgG (AQP4-IgG) and multiple sclerosis (MS). Design, Setting, and Participants: We retrospectively identified 199 MOG-IgG-positive Mayo Clinic patients from January 1, 2000, through December 31, 2017, through our neuroimmunology laboratory. Fifty-four patients met inclusion criteria of (1) clinical myelitis; (2) MOG-IgG positivity; and (3) medical records available. We excluded 145 patients without documented myelitis. Myelitis of AQP4-IgG (n = 46) and MS (n = 26) were used for comparison. Main Outcomes and Measures: Outcome variables included modified Rankin score and need for gait aid. A neuroradiologist analyzed spine magnetic resonance imaging of patients with MOG-IgG and control patients blinded to diagnosis. Results: Of 54 included patients with MOG-IgG myelitis, the median age was 25 years (range, 3-73 years) and 24 were women (44%). Isolated transverse myelitis was the initial manifestation in 29 patients (54%), and 10 (19%) were initially diagnosed as having viral/postviral acute flaccid myelitis. Cerebrospinal fluid-elevated oligoclonal bands occurred in 1 of 38 (3%). At final follow-up (median, 24 months; range, 2-120 months), 32 patients (59%) had developed 1 or more relapses of optic neuritis (n = 31); transverse myelitis (n = 7); or acute disseminated encephalomyelitis (n = 1). Clinical features favoring MOG-IgG myelitis vs AQP4-IgG or MS myelitis included prodromal symptoms and concurrent acute disseminated encephalomyelitis. Magnetic resonance imaging features favoring MOG-IgG over AQP4-IgG or MS myelitis were T2-signal abnormality confined to gray matter (sagittal line and axial H sign) and lack of enhancement. Longitudinally extensive T2 lesions were of similar frequency in MOG-IgG and AQP4-IgG myelitis (37 of 47 [79%] vs 28 of 34 [82%]; P = .52) but not found in MS. Multiple spinal cord lesions and conus involvement were more frequent with MOG-IgG than AQP4-IgG but not different from MS. Wheelchair dependence at myelitis nadir occurred in one-third of patients with MOG-IgG and AQP4-IgG but never with MS, although patients with MOG-IgG myelitis recovered better than those with AQP4-IgG. Conclusions and Relevance: Myelitis is an early manifestation of MOG-IgG-related disease and may have a clinical phenotype of acute flaccid myelitis. We identified a variety of clinical and magnetic resonance imaging features that may help clinicians identify those at risk in whom MOG-IgG should be tested. SN - 2168-6157 UR - https://www.unboundmedicine.com/medline/citation/30575890/Clinical_Radiologic_and_Prognostic_Features_of_Myelitis_Associated_With_Myelin_Oligodendrocyte_Glycoprotein_Autoantibody_ L2 - https://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2018.4053 DB - PRIME DP - Unbound Medicine ER -