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_ DB - PRIME DP - Unbound Medicine ER -