Myelin Oligodendrocyte Glycoprotein Antibody-Positive Optic Neuritis: Clinical Characteristics, Radiologic Clues, and Outcome

Am J Ophthalmol. 2018 Nov;195:8-15. doi: 10.1016/j.ajo.2018.07.020. Epub 2018 Jul 26.

Abstract

Purpose: To characterize the clinical phenotype of myelin oligodendrocyte glycoprotein antibody (MOG-IgG) optic neuritis.

Design: Observational case series.

Methods: Setting: Multicenter. Patient/Study Population: Subjects meeting inclusion criteria: (1) history of optic neuritis; (2) seropositivity (MOG-IgG binding index > 2.5); 87 MOG-IgG-seropositive patients with optic neuritis were included (Mayo Clinic, 76; other medical centers, 11). MOG-IgG was detected using full-length MOG-transfected live HEK293 cells in a clinically validated flow cytometry assay.

Main outcome measures: Clinical and radiologic characteristics and visual outcomes.

Results: Fifty-seven percent were female and median age at onset was 31 (range 2-79) years. Median number of optic neuritis attacks was 3 (range 1-8), median follow-up 2.9 years (range 0.5-24 years), and annualized relapse rate 0.8. Average visual acuity (VA) at nadir of worst attack was count fingers. Average final VA was 20/30; for 5 patients (6%) it was ≤20/200 in either eye. Optic disc edema and pain each occurred in 86% of patients. Magnetic resonance imaging showed perineural enhancement in 50% and longitudinally extensive involvement in 80%. Twenty-six patients (30%) had recurrent optic neuritis without other neurologic symptoms, 10 (12%) had single optic neuritis, 14 (16%) had chronic relapsing inflammatory optic neuropathy, and 36 (41%) had optic neuritis with other neurologic symptoms (most neuromyelitis optica spectrum disorder-like phenotype or acute disseminated encephalomyelitis). Only 1 patient was diagnosed with MS (MOG-IgG-binding index 2.8; normal range ≤ 2.5). Persistent MOG-IgG seropositivity occurred in 61 of 62 (98%). A total of 61% received long-term immunosuppressant therapy.

Conclusions: Manifestations of MOG-IgG-positive optic neuritis are diverse. Despite recurrent attacks with severe vision loss, the majority of patients have significant recovery and retain functional vision long-term.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age of Onset
  • Aged
  • Autoantibodies / blood*
  • Child
  • Child, Preschool
  • Eye Pain / diagnosis
  • Female
  • Flow Cytometry
  • Fluorescent Antibody Technique, Indirect
  • HEK293 Cells
  • Humans
  • Immunoglobulin G / blood
  • Immunosuppressive Agents / therapeutic use
  • Magnetic Resonance Imaging*
  • Male
  • Middle Aged
  • Myelin-Oligodendrocyte Glycoprotein / immunology*
  • Optic Neuritis / diagnostic imaging*
  • Optic Neuritis / drug therapy
  • Optic Neuritis / immunology*
  • Papilledema / diagnosis
  • Phenotype
  • Retrospective Studies
  • Transfection
  • Vision Disorders / physiopathology
  • Visual Acuity / physiology

Substances

  • Autoantibodies
  • Immunoglobulin G
  • Immunosuppressive Agents
  • Myelin-Oligodendrocyte Glycoprotein