MOG encephalomyelitis: International recommendations on diagnosis and antibody testing

S. Jarius, F. Paul, O. Aktas, N. Asgari, R. C. Dale, J. de Seze, D. Franciotta, K. Fujihara, A. Jacob, H. J. Kim, I. Kleiter, T. Kümpfel, M. Levy, J. Palace, K. Ruprecht, A. Saiz, C. Trebst, B. G. Weinshenker, B. Wildemann

Research output: Contribution to journalReview article

166 Scopus citations

Abstract

Over the past few years, new-generation cell-based assays have demonstrated a robust association of autoantibodies to full-length human myelin oligodendrocyte glycoprotein (MOG-IgG) with (mostly recurrent) optic neuritis, myelitis and brainstem encephalitis, as well as with acute disseminated encephalomyelitis (ADEM)-like presentations. Most experts now consider MOG-IgG-associated encephalomyelitis (MOG-EM) a disease entity in its own right, immunopathogenetically distinct from both classic multiple sclerosis (MS) and aquaporin-4 (AQP4)-IgG-positive neuromyelitis optica spectrum disorders (NMOSD). Owing to a substantial overlap in clinicoradiological presentation, MOG-EM was often unwittingly misdiagnosed as MS in the past. Accordingly, increasing numbers of patients with suspected or established MS are currently being tested for MOG-IgG. However, screening of large unselected cohorts for rare biomarkers can significantly reduce the positive predictive value of a test. To lessen the hazard of overdiagnosing MOG-EM, which may lead to inappropriate treatment, more selective criteria for MOG-IgG testing are urgently needed. In this paper, we propose indications for MOG-IgG testing based on expert consensus. In addition, we give a list of conditions atypical for MOG-EM ("red flags") that should prompt physicians to challenge a positive MOG-IgG test result. Finally, we provide recommendations regarding assay methodology, specimen sampling and data interpretation.

Original languageEnglish (US)
Article number134
JournalJournal of Neuroinflammation
Volume15
Issue number1
DOIs
StatePublished - May 3 2018

Keywords

  • Antibody testing
  • Consensus recommendations
  • Diagnosis
  • Multiple sclerosis (MS)
  • Myelin oligodendrocyte glycoprotein (MOG) antibodies
  • Neuromyelitis optica spectrum disorders (NMOSD)
  • Optic neuritis (ON), Myelitis

ASJC Scopus subject areas

  • Neuroscience(all)
  • Immunology
  • Neurology
  • Cellular and Molecular Neuroscience

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    Jarius, S., Paul, F., Aktas, O., Asgari, N., Dale, R. C., de Seze, J., Franciotta, D., Fujihara, K., Jacob, A., Kim, H. J., Kleiter, I., Kümpfel, T., Levy, M., Palace, J., Ruprecht, K., Saiz, A., Trebst, C., Weinshenker, B. G., & Wildemann, B. (2018). MOG encephalomyelitis: International recommendations on diagnosis and antibody testing. Journal of Neuroinflammation, 15(1), [134]. https://doi.org/10.1186/s12974-018-1144-2