Neuromyelitis Optica and Anti-MOG Disease Poster Presentation

P0703 - Clinical, radiological features and management of twenty patients diagnosed with anti-MOG demyelinating syndrome in a tertiary referral centre. (ID 1857)

Speakers
  • M. Gaughan
Authors
  • M. Gaughan
  • C. O'Brien
  • C. McGuigan
Presentation Number
P0703
Presentation Topic
Neuromyelitis Optica and Anti-MOG Disease

Abstract

Background

Myelin Oligodendrocyte Glycoprotein (MOG) – antibody demyelinating disease has emerged as a distinct clinical entity in recent years. Prevalence is also likely higher than previously recognized. MOG antibody testing is standard of care in new presentations, however a significant population remains undiagnosed. Identifying this cohort requires clinical vigilance.

Objectives

To characterize the clinical course, treatment and outcomes in 20 patients diagnosed with MOG demyelinating syndrome between 2018 and 2020.

Methods

We evaluated clinical phenotype, demographic data, historical episodes and radiological findings in 20 patients attending the demyelination clinic in our institution who tested positive for myelin oligodendrocyte glycoprotein between 2018 and 2020. This patient cohort included new presentations with optic neuritis and myelitis and patients with a previous diagnosis of multiple sclerosis and chronic relapsing idiopathic optic neuropathy.

Results

52% of the cohort were female. The median age at diagnosis was 35 years, however the median age at initial clinical presentation was 22.5 years (age range 4-60). 70% had optic neuritis as their initial presenting complaint. 95% had clinical or radiological evidence of optic neuritis during their clinical course. ADEM had occurred in 3/4 patients who had presented before the age of 10. Recurrence was common - 75% of the cohort had subsequent clinical episodes. 65% of those with recurrence had a second event within six months of presentation. The longest duration between first and second clinical episodes was 25 years. 60% of the cohort had CSF sampling and OCBs were negative in all cases. Long term antibody positivity despite clinical and radiological quiescence was common. Radiological features included retrobulbar high signal of the optic nerves, chiasmal atrophy, leptomeningeal enhancement and spinal cord lesions. Resolution of radiological features was common.

Conclusions

MOG antibody associated demyelination frequently presents with optic neuritis. Recurrence is common and can occur many years after the initial presentation, making long term management challenging. There is an excellent response to steroids in the acute phase. Asymptomatic optic nerve lesions and cord lesions do occur, and imaging of the neuraxis at presentation should be considered. Consideration should be given to MOG antibody testing in patients transitioning to adult MS services from the paediatric population. The role of longer-term immunosuppression in the cohort is typically reserved for those with recurrence.

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