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

John Chen, Eoin Flanagan, Jiraporn Jitprapaikulsan, Alfonso (Sebastian) S. López-Chiriboga, James P. Fryer, Jacqueline A. Leavitt, Brian G Weinshenker, Andrew McKeon, Jan-Mendelt Tillema, Vanda A Lennon, W. Oliver Tobin, B Mark Keegan, Claudia F Lucchinetti, Orhun H Kantarci, Collin M. McClelland, Michael S. Lee, Jeffrey L. Bennett, Victoria S. Pelak, Yanjun Chen, Gregory VanStavernOre Ofe O. Adesina, Eric R. Eggenberger, Marie D. Acierno, Dean Marko Wingerchuk, Paul W. Brazis, Jessica Sagen, Sean J Pittock

Research output: Contribution to journalArticle

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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.

Original languageEnglish (US)
Pages (from-to)8-15
Number of pages8
JournalAmerican Journal of Ophthalmology
Volume195
DOIs
StatePublished - Nov 1 2018

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Myelin-Oligodendrocyte Glycoprotein
Optic Neuritis
Immunoglobulin G
Neurologic Manifestations
Visual Acuity
Acute Disseminated Encephalomyelitis
Neuromyelitis Optica
Phenotype
Optic Nerve Diseases
Papilledema
HEK293 Cells
Immunosuppressive Agents
Age of Onset
Fingers
Flow Cytometry
Reference Values
Magnetic Resonance Imaging
Recurrence
Pain

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Myelin Oligodendrocyte Glycoprotein Antibody–Positive Optic Neuritis : Clinical Characteristics, Radiologic Clues, and Outcome. / Chen, John; Flanagan, Eoin; Jitprapaikulsan, Jiraporn; López-Chiriboga, Alfonso (Sebastian) S.; Fryer, James P.; Leavitt, Jacqueline A.; Weinshenker, Brian G; McKeon, Andrew; Tillema, Jan-Mendelt; Lennon, Vanda A; Tobin, W. Oliver; Keegan, B Mark; Lucchinetti, Claudia F; Kantarci, Orhun H; McClelland, Collin M.; Lee, Michael S.; Bennett, Jeffrey L.; Pelak, Victoria S.; Chen, Yanjun; VanStavern, Gregory; Adesina, Ore Ofe O.; Eggenberger, Eric R.; Acierno, Marie D.; Wingerchuk, Dean Marko; Brazis, Paul W.; Sagen, Jessica; Pittock, Sean J.

In: American Journal of Ophthalmology, Vol. 195, 01.11.2018, p. 8-15.

Research output: Contribution to journalArticle

Chen, John ; Flanagan, Eoin ; Jitprapaikulsan, Jiraporn ; López-Chiriboga, Alfonso (Sebastian) S. ; Fryer, James P. ; Leavitt, Jacqueline A. ; Weinshenker, Brian G ; McKeon, Andrew ; Tillema, Jan-Mendelt ; Lennon, Vanda A ; Tobin, W. Oliver ; Keegan, B Mark ; Lucchinetti, Claudia F ; Kantarci, Orhun H ; McClelland, Collin M. ; Lee, Michael S. ; Bennett, Jeffrey L. ; Pelak, Victoria S. ; Chen, Yanjun ; VanStavern, Gregory ; Adesina, Ore Ofe O. ; Eggenberger, Eric R. ; Acierno, Marie D. ; Wingerchuk, Dean Marko ; Brazis, Paul W. ; Sagen, Jessica ; Pittock, Sean J. / Myelin Oligodendrocyte Glycoprotein Antibody–Positive Optic Neuritis : Clinical Characteristics, Radiologic Clues, and Outcome. In: American Journal of Ophthalmology. 2018 ; Vol. 195. pp. 8-15.
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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.",
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T1 - Myelin Oligodendrocyte Glycoprotein Antibody–Positive Optic Neuritis

T2 - Clinical Characteristics, Radiologic Clues, and Outcome

AU - Chen, John

AU - Flanagan, Eoin

AU - Jitprapaikulsan, Jiraporn

AU - López-Chiriboga, Alfonso (Sebastian) S.

AU - Fryer, James P.

AU - Leavitt, Jacqueline A.

AU - Weinshenker, Brian G

AU - McKeon, Andrew

AU - Tillema, Jan-Mendelt

AU - Lennon, Vanda A

AU - Tobin, W. Oliver

AU - Keegan, B Mark

AU - Lucchinetti, Claudia F

AU - Kantarci, Orhun H

AU - McClelland, Collin M.

AU - Lee, Michael S.

AU - Bennett, Jeffrey L.

AU - Pelak, Victoria S.

AU - Chen, Yanjun

AU - VanStavern, Gregory

AU - Adesina, Ore Ofe O.

AU - Eggenberger, Eric R.

AU - Acierno, Marie D.

AU - Wingerchuk, Dean Marko

AU - Brazis, Paul W.

AU - Sagen, Jessica

AU - Pittock, Sean J

PY - 2018/11/1

Y1 - 2018/11/1

N2 - 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.

AB - 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.

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