Evaluation of diagnostic criteria and red flags of myelin oligodendrocyte glycoprotein encephalomyelitis in a clinical routine cohort

Aims Myelin oligodendrocyte glycoprotein antibodies (MOG‐IgG) have been proposed to define “MOG encephalomyelitis” (MOG‐EM), with published diagnostic and “red flag” criteria. We aimed to evaluate these criteria in a routine clinical setting. Methods We retrospectively analyzed patients with borderl...

Full description

Saved in:
Bibliographic Details
Published in:CNS neuroscience & therapeutics 2021-04, Vol.27 (4), p.426-438
Main Authors: Veselaj, Krenar, Kamber, Nicole, Briner, Myriam, Friedli, Christoph, Diem, Lara, Guse, Kirsten, Miclea, Andrei, Wiest, Roland, Wagner, Franca, Grabe, Hilary, Abegg, Mathias, Horn, Michael P., Bigi, Sandra, Chan, Andrew, Hoepner, Robert, Salmen, Anke
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aquaporins
Autoantibodies - blood
Cerebrospinal fluid
Clinical medicine
Cohort Studies
Committees
Consent
Disease
Encephalomyelitis
Encephalomyelitis - blood
Encephalomyelitis - diagnostic imaging
Ethics
Female
Flags
Glycoproteins
HEK293 Cells
Humans
Immunoglobulin G
Immunoglobulin G - blood
Immunoglobulins
Laboratories
Magnetic resonance imaging
Magnetic Resonance Imaging - trends
Male
Multiple sclerosis
Myelin
myelin oligodendrocyte glycoprotein
Myelin-Oligodendrocyte Glycoprotein - blood
neuromyelitis optica spectrum disorders
Oligodendrocyte-myelin glycoprotein
Original
Patients
Retrospective Studies
Young Adult
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Aims Myelin oligodendrocyte glycoprotein antibodies (MOG‐IgG) have been proposed to define “MOG encephalomyelitis” (MOG‐EM), with published diagnostic and “red flag” criteria. We aimed to evaluate these criteria in a routine clinical setting. Methods We retrospectively analyzed patients with borderline/positive MOG‐IgG and applied the diagnostic and red flag criteria to determine likelihood of MOG‐EM diagnosis. Para‐/clinical parameters were described and analyzed with chi‐square test. Results In total, 37 patients fulfilled MOG‐EM diagnostic criteria (female‐to‐male ratio: 1.6:1, median onset age: 28.0 years [IQR 18.5‐40.5], n = 8 with pediatric onset). In 24/37, red flags were present, predominantly MOG‐IgG at assay cutoff and/or MRI lesions suggestive of multiple sclerosis (MS). As proposed in the consensus criteria, these patients should rather be described as “possible” MOG‐EM. Of these, we classified 13 patients as “unlikely” MOG‐EM in the presence of the red flag “borderline MOG‐IgG” with negative MOG‐IgG retest or coincidence of ≥1 additional red flag. This group mainly consisted of patients diagnosed with MS (n = 11). Frequency of cerebrospinal fluid (CSF‐)—specific oligoclonal bands (OCB) is significantly lower in definite vs possible and unlikely MOG‐EM (P = .0005). Conclusion Evaluation of diagnostic and red flag criteria, MOG‐IgG retesting (incl. change of assay), and CSF‐specific OCB are relevant in clinical routine cohorts to differentiate MOG‐EM from MS. Differential diagnosis of MOG encephalomyelitis vs. MS is crucial. Application of consensus diagnostic criteria and proposed red flags is helpful in a clinical routine cohort, and MOG‐IgG retesting (incl. change of assay) as well as evaluation of CSF‐specific OCB may further help in the distinction of the two entities.
ISSN:1755-5930
1755-5949
DOI:10.1111/cns.13461