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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...
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| Published in: | CNS neuroscience & therapeutics 2021-04, Vol.27 (4), p.426-438 |
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| creator | 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 |
| description | 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. |
| doi_str_mv | 10.1111/cns.13461 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7941167</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2450650611</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4431-129f38e5bd7685218a16eac8cd99c8d2fcee73a01234e5391c2e3b0239c2eb9d3</originalsourceid><addsrcrecordid>eNp1kV1rFDEUhoMotlYv_AMS8EYvts3XzCQ3giz1A4peqNchm5yZTckma5KpzA_wf5t266KCIZBDzpOHE16EnlNyTtu6sLGcUy56-gCd0qHrVp0S6uGx5uQEPSnlmpCeSSUfoxPOiRikEqfo5-WNCbOpPkWcRuy8mWIq1Vtss6-QvcEmOpzB4TGYqdxCuwWCb3jwU3IQXU52qYCnsNi0z6lCa0K0sN-akO7g6gtulwbb9tBbE3BOc_URsE3blOtT9Gg0ocCz-_MMfXt3-XX9YXX1-f3H9durlRWC0xVlauQSuo0betkxKg3twVhpnVJWOjZagIEbQhkX0HFFLQO-IYyrVmyU42fozcG7nzc7cBZizSboffY7kxedjNd_d6Lf6ind6EEJSvuhCV7dC3L6PkOpeueLhRBMhDQXzURH-rYpbejLf9DrNOfYvtcoJaVkw6Aa9fpA2ZxKyTAeh6FE34arW7j6LtzGvvhz-iP5O80GXByAHz7A8n-TXn_6clD-AvDvslw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2498882779</pqid></control><display><type>article</type><title>Evaluation of diagnostic criteria and red flags of myelin oligodendrocyte glycoprotein encephalomyelitis in a clinical routine cohort</title><source>Wiley-Blackwell Open Access Collection</source><source>Open Access: PubMed Central</source><source>Publicly Available Content Database</source><creator>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</creator><creatorcontrib>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</creatorcontrib><description>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.</description><identifier>ISSN: 1755-5930</identifier><identifier>EISSN: 1755-5949</identifier><identifier>DOI: 10.1111/cns.13461</identifier><identifier>PMID: 33047894</identifier><language>eng</language><publisher>England: John Wiley & Sons, Inc</publisher><subject>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</subject><ispartof>CNS neuroscience & therapeutics, 2021-04, Vol.27 (4), p.426-438</ispartof><rights>2020 The Authors. Published by John Wiley & Sons Ltd.</rights><rights>2020 The Authors. CNS Neuroscience & Therapeutics Published by John Wiley & Sons Ltd.</rights><rights>2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4431-129f38e5bd7685218a16eac8cd99c8d2fcee73a01234e5391c2e3b0239c2eb9d3</citedby><cites>FETCH-LOGICAL-c4431-129f38e5bd7685218a16eac8cd99c8d2fcee73a01234e5391c2e3b0239c2eb9d3</cites><orcidid>0000-0002-0115-7021 ; 0000-0002-4751-299X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2498882779/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2498882779?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,315,733,786,790,891,11589,25783,27957,27958,37047,37048,44625,46087,46511,53827,53829,75483</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33047894$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Veselaj, Krenar</creatorcontrib><creatorcontrib>Kamber, Nicole</creatorcontrib><creatorcontrib>Briner, Myriam</creatorcontrib><creatorcontrib>Friedli, Christoph</creatorcontrib><creatorcontrib>Diem, Lara</creatorcontrib><creatorcontrib>Guse, Kirsten</creatorcontrib><creatorcontrib>Miclea, Andrei</creatorcontrib><creatorcontrib>Wiest, Roland</creatorcontrib><creatorcontrib>Wagner, Franca</creatorcontrib><creatorcontrib>Grabe, Hilary</creatorcontrib><creatorcontrib>Abegg, Mathias</creatorcontrib><creatorcontrib>Horn, Michael P.</creatorcontrib><creatorcontrib>Bigi, Sandra</creatorcontrib><creatorcontrib>Chan, Andrew</creatorcontrib><creatorcontrib>Hoepner, Robert</creatorcontrib><creatorcontrib>Salmen, Anke</creatorcontrib><title>Evaluation of diagnostic criteria and red flags of myelin oligodendrocyte glycoprotein encephalomyelitis in a clinical routine cohort</title><title>CNS neuroscience & therapeutics</title><addtitle>CNS Neurosci Ther</addtitle><description>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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aquaporins</subject><subject>Autoantibodies - blood</subject><subject>Cerebrospinal fluid</subject><subject>Clinical medicine</subject><subject>Cohort Studies</subject><subject>Committees</subject><subject>Consent</subject><subject>Disease</subject><subject>Encephalomyelitis</subject><subject>Encephalomyelitis - blood</subject><subject>Encephalomyelitis - diagnostic imaging</subject><subject>Ethics</subject><subject>Female</subject><subject>Flags</subject><subject>Glycoproteins</subject><subject>HEK293 Cells</subject><subject>Humans</subject><subject>Immunoglobulin G</subject><subject>Immunoglobulin G - blood</subject><subject>Immunoglobulins</subject><subject>Laboratories</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - trends</subject><subject>Male</subject><subject>Multiple sclerosis</subject><subject>Myelin</subject><subject>myelin oligodendrocyte glycoprotein</subject><subject>Myelin-Oligodendrocyte Glycoprotein - blood</subject><subject>neuromyelitis optica spectrum disorders</subject><subject>Oligodendrocyte-myelin glycoprotein</subject><subject>Original</subject><subject>Patients</subject><subject>Retrospective Studies</subject><subject>Young Adult</subject><issn>1755-5930</issn><issn>1755-5949</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>WIN</sourceid><sourceid>PIMPY</sourceid><recordid>eNp1kV1rFDEUhoMotlYv_AMS8EYvts3XzCQ3giz1A4peqNchm5yZTckma5KpzA_wf5t266KCIZBDzpOHE16EnlNyTtu6sLGcUy56-gCd0qHrVp0S6uGx5uQEPSnlmpCeSSUfoxPOiRikEqfo5-WNCbOpPkWcRuy8mWIq1Vtss6-QvcEmOpzB4TGYqdxCuwWCb3jwU3IQXU52qYCnsNi0z6lCa0K0sN-akO7g6gtulwbb9tBbE3BOc_URsE3blOtT9Gg0ocCz-_MMfXt3-XX9YXX1-f3H9durlRWC0xVlauQSuo0betkxKg3twVhpnVJWOjZagIEbQhkX0HFFLQO-IYyrVmyU42fozcG7nzc7cBZizSboffY7kxedjNd_d6Lf6ind6EEJSvuhCV7dC3L6PkOpeueLhRBMhDQXzURH-rYpbejLf9DrNOfYvtcoJaVkw6Aa9fpA2ZxKyTAeh6FE34arW7j6LtzGvvhz-iP5O80GXByAHz7A8n-TXn_6clD-AvDvslw</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Veselaj, Krenar</creator><creator>Kamber, Nicole</creator><creator>Briner, Myriam</creator><creator>Friedli, Christoph</creator><creator>Diem, Lara</creator><creator>Guse, Kirsten</creator><creator>Miclea, Andrei</creator><creator>Wiest, Roland</creator><creator>Wagner, Franca</creator><creator>Grabe, Hilary</creator><creator>Abegg, Mathias</creator><creator>Horn, Michael P.</creator><creator>Bigi, Sandra</creator><creator>Chan, Andrew</creator><creator>Hoepner, Robert</creator><creator>Salmen, Anke</creator><general>John Wiley & Sons, Inc</general><general>John Wiley and Sons Inc</general><scope>24P</scope><scope>WIN</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>8AO</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>LK8</scope><scope>M0S</scope><scope>M7P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-0115-7021</orcidid><orcidid>https://orcid.org/0000-0002-4751-299X</orcidid></search><sort><creationdate>202104</creationdate><title>Evaluation of diagnostic criteria and red flags of myelin oligodendrocyte glycoprotein encephalomyelitis in a clinical routine cohort</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4431-129f38e5bd7685218a16eac8cd99c8d2fcee73a01234e5391c2e3b0239c2eb9d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aquaporins</topic><topic>Autoantibodies - blood</topic><topic>Cerebrospinal fluid</topic><topic>Clinical medicine</topic><topic>Cohort Studies</topic><topic>Committees</topic><topic>Consent</topic><topic>Disease</topic><topic>Encephalomyelitis</topic><topic>Encephalomyelitis - blood</topic><topic>Encephalomyelitis - diagnostic imaging</topic><topic>Ethics</topic><topic>Female</topic><topic>Flags</topic><topic>Glycoproteins</topic><topic>HEK293 Cells</topic><topic>Humans</topic><topic>Immunoglobulin G</topic><topic>Immunoglobulin G - blood</topic><topic>Immunoglobulins</topic><topic>Laboratories</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging - trends</topic><topic>Male</topic><topic>Multiple sclerosis</topic><topic>Myelin</topic><topic>myelin oligodendrocyte glycoprotein</topic><topic>Myelin-Oligodendrocyte Glycoprotein - blood</topic><topic>neuromyelitis optica spectrum disorders</topic><topic>Oligodendrocyte-myelin glycoprotein</topic><topic>Original</topic><topic>Patients</topic><topic>Retrospective Studies</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Veselaj, Krenar</creatorcontrib><creatorcontrib>Kamber, Nicole</creatorcontrib><creatorcontrib>Briner, Myriam</creatorcontrib><creatorcontrib>Friedli, Christoph</creatorcontrib><creatorcontrib>Diem, Lara</creatorcontrib><creatorcontrib>Guse, Kirsten</creatorcontrib><creatorcontrib>Miclea, Andrei</creatorcontrib><creatorcontrib>Wiest, Roland</creatorcontrib><creatorcontrib>Wagner, Franca</creatorcontrib><creatorcontrib>Grabe, Hilary</creatorcontrib><creatorcontrib>Abegg, Mathias</creatorcontrib><creatorcontrib>Horn, Michael P.</creatorcontrib><creatorcontrib>Bigi, Sandra</creatorcontrib><creatorcontrib>Chan, Andrew</creatorcontrib><creatorcontrib>Hoepner, Robert</creatorcontrib><creatorcontrib>Salmen, Anke</creatorcontrib><collection>Wiley-Blackwell Open Access Collection</collection><collection>Wiley Online Library</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection (Proquest)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection (Proquest) (PQ_SDU_P3)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biological Sciences</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Biological Science Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>CNS neuroscience & therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Veselaj, Krenar</au><au>Kamber, Nicole</au><au>Briner, Myriam</au><au>Friedli, Christoph</au><au>Diem, Lara</au><au>Guse, Kirsten</au><au>Miclea, Andrei</au><au>Wiest, Roland</au><au>Wagner, Franca</au><au>Grabe, Hilary</au><au>Abegg, Mathias</au><au>Horn, Michael P.</au><au>Bigi, Sandra</au><au>Chan, Andrew</au><au>Hoepner, Robert</au><au>Salmen, Anke</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of diagnostic criteria and red flags of myelin oligodendrocyte glycoprotein encephalomyelitis in a clinical routine cohort</atitle><jtitle>CNS neuroscience & therapeutics</jtitle><addtitle>CNS Neurosci Ther</addtitle><date>2021-04</date><risdate>2021</risdate><volume>27</volume><issue>4</issue><spage>426</spage><epage>438</epage><pages>426-438</pages><issn>1755-5930</issn><eissn>1755-5949</eissn><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Undefined-1</notes><notes>ObjectType-Feature-3</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>England</cop><pub>John Wiley & Sons, Inc</pub><pmid>33047894</pmid><doi>10.1111/cns.13461</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-0115-7021</orcidid><orcidid>https://orcid.org/0000-0002-4751-299X</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | CNS neuroscience & therapeutics, 2021-04, Vol.27 (4), p.426-438 |
| issn | 1755-5930 1755-5949 |
| language | eng |
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| source | Wiley-Blackwell Open Access Collection; Open Access: PubMed Central; Publicly Available Content Database |
| 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 |
| title | Evaluation of diagnostic criteria and red flags of myelin oligodendrocyte glycoprotein encephalomyelitis in a clinical routine cohort |
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