What proportion of AQP4-IgG-negative NMO spectrum disorder patients are MOG-IgG positive? A cross sectional study of 132 patients

J Neurol. 2017 Oct;264(10):2088-2094. doi: 10.1007/s00415-017-8596-7. Epub 2017 Aug 24.


Antibodies to myelin oligodendrocyte glycoprotein (MOG-IgG) have been described in patients with neuromyelitis optica spectrum disorders (NMOSD) without aquaporin-4 antibodies (AQP4-IgG). We aimed to identify the proportion of AQP4-IgG-negative NMOSD patients who are seropositive for MOG-IgG. In a cross sectional study, we reviewed all patients seen in the National NMO clinic over the last 4 years (after the availability of MOG-IgG testing), including clinical information, MRI, and antibody tests. 261 unique patients were identified. 132 cases satisfied the 2015 NMOSD diagnostic criteria. Of these, 96 (73%) were AQP4-IgG positive and 36 (27%) were AQP4-IgG negative. These 36 patients were tested for MOG-IgG and 15/36 (42%) tested positive. 20% (25/125) of the patients who did not satisfy NMOSD criteria had MOG-IgG. Approximately half of seronegative NMOSD is MOG-Ig seropositive and one in five of non-NMOSD/non-MS demyelination is MOG-IgG positive. Since MOG-associated demyelinating disease is likely different from AQP4-IgG disease in terms of underlying disease mechanisms, relapse risk and possibly treatment, testing for MOG-IgG in patients with AQP4-IgG-negative NMOSD and other non-MS demyelination may have significant implications to management and clinical trials.

Keywords: Aquaporin-4 antibodies; Myelin oligodendrocytes glycoprotein; Neuromyelitis optica.

MeSH terms

  • Adolescent
  • Adult
  • Aquaporin 4 / immunology*
  • Cross-Sectional Studies
  • Demyelinating Diseases / blood
  • Demyelinating Diseases / immunology
  • Female
  • Humans
  • Immunoglobulin G / blood*
  • Immunosuppressive Agents / therapeutic use
  • Male
  • Middle Aged
  • Myelin-Oligodendrocyte Glycoprotein / immunology*
  • Neuromyelitis Optica / blood*
  • Neuromyelitis Optica / drug therapy
  • Neuromyelitis Optica / epidemiology*
  • Neuromyelitis Optica / immunology*
  • Young Adult


  • Aquaporin 4
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Myelin-Oligodendrocyte Glycoprotein