RT Journal Article
SR Electronic
T1 Temporal Dynamics of MOG Antibodies in Children With Acquired Demyelinating Syndrome
JF Neurology - Neuroimmunology Neuroinflammation
JO Neurol Neuroimmunol Neuroinflamm
FD Lippincott Williams & Wilkins
SP e200035
DO 10.1212/NXI.0000000000200035
VO 9
IS 6
A1 Wendel, Eva Maria
A1 Thonke, Helen Sophie
A1 Bertolini, Annikki
A1 Baumann, Matthias
A1 Blaschek, Astrid
A1 Merkenschlager, Andreas
A1 Karenfort, Michael
A1 Kornek, Barbara
A1 Lechner, Christian
A1 Pohl, Daniela
A1 Pritsch, Martin
A1 Schanda, Kathrin
A1 Schimmel, Mareike
A1 Thiels, Charlotte
A1 Waltz, Stephan
A1 Wiegand, Gert
A1 Anlar, Banu
A1 Barisic, Nina
A1 Blank, Christian
A1 Breu, Markus
A1 Broser, Philip
A1 Della Marina, Adela
A1 Diepold, Katharina
A1 Eckenweiler, Matthias
A1 Eisenkölbl, Astrid
A1 Freilinger, Michael
A1 Gruber-Sedlmayr, Ursula
A1 Hackenberg, Annette
A1 Iff, Tobias
A1 Knierim, Ellen
A1 Koch, Johannes
A1 Kutschke, Georg
A1 Leiz, Steffen
A1 Lischetzki, Grischa
A1 Nosadini, Margherita
A1 Pschibul, Alexander
A1 Reiter-Fink, Edith
A1 Rohrbach, Doris
A1 Salandin, Michela
A1 Sartori, Stefano
A1 Schlump, Jan-Ulrich
A1 Stoffels, Johannes
A1 Strautmanis, Jurgis
A1 Tibussek, Daniel
A1 Tüngler, Victoria
A1 Utzig, Norbert
A1 Reindl, Markus
A1 Rostásy, Kevin
A1 ,
YR 2022
UL http://nn.neurology.org/content/9/6/e200035.abstract
AB Background and Objective The spectrum of myelin oligodendrocyte glycoprotein (MOG) antibody–associated disorder (MOGAD) comprises monophasic diseases such as acute disseminated encephalomyelitis (ADEM), optic neuritis (ON), and transverse myelitis and relapsing courses of these presentations. Persistently high MOG antibodies (MOG immunoglobulin G [IgG]) are found in patients with a relapsing disease course. Prognostic factors to determine the clinical course of children with a first MOGAD are still lacking. The objective of the study is to assess the clinical and laboratory prognostic parameters for a risk of relapse and the temporal dynamics of MOG‐IgG titers in children with MOGAD in correlation with clinical presentation and disease course.Methods In this prospective multicenter hospital-based study, children with a first demyelinating attack and complete data set comprising clinical and radiologic findings, MOG-IgG titer at onset, and clinical and serologic follow-up data were included. Serum samples were analyzed by live cell-based assay, and a titer level of ≥1:160 was classified as MOG-IgG–positive.Results One hundred sixteen children (f:m = 57:59) with MOGAD were included and initially diagnosed with ADEM (n = 59), unilateral ON (n = 12), bilateral ON (n = 16), myelitis (n = 6), neuromyelitis optica spectrum disorder (n = 8) or encephalitis (n = 6). The median follow-up time was 3 years in monophasic and 5 years in relapsing patients. There was no significant association between disease course and MOG-IgG titers at onset, sex, age at presentation, or clinical phenotype. Seroconversion to MOG-IgG–negative within 2 years of the initial event showed a significant risk reduction for a relapsing disease course. Forty-two/one hundred sixteen patients (monophasic n = 26, relapsing n = 16) had serial MOG-IgG testing in years 1 and 2 after the initial event. In contrast to relapsing patients, monophasic patients showed a significant decrease of MOG-IgG titers during the first and second years, often with seroconversion to negative titers. During the follow-up, MOG-IgG titers were persistently higher in relapsing than in monophasic patients. Decrease in MOG-IgG of ≥3 dilution steps after the first and second years was shown to be associated with a decreased risk of relapses. In our cohort, no patient experienced a relapse after seroconversion to MOG-IgG–negative.Discussion In this study, patients with declining MOG-IgG titers, particularly those with seroconversion to MOG-IgG–negative, are shown to have a significantly reduced relapse risk.ADEM=acute disseminated encephalomyelitis; ADEMON=acute disseminated encephalomyelitis, followed by optic neuritis; ADS=acute/acquired demyelinating syndrome; DMT=disease-modifying therapy; EDSS=expanded disability status scale; FU=follow-up; IgG=immunoglobulin G; IQR=interquartile range; IVIG=intravenous immunoglobulin; MDEM=multiphasic acute disseminated encephalomyelitis; MOG=myelin oligodendrocyte glycoprotein; MOGAD=MOG-IgG associated disorder; NMOSD=neuromyelitis optica spectrum disorder; OCBs=oligoclonal bands; ON rec=recurrent optic neuritis; ON=optic neuritis; PLEX=plasma exchange; TM=transverse myelitis