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 Eva Maria Wendel
A1 Helen Sophie Thonke
A1 Annikki Bertolini
A1 Matthias Baumann
A1 Astrid Blaschek
A1 Andreas Merkenschlager
A1 Michael Karenfort
A1 Barbara Kornek
A1 Christian Lechner
A1 Daniela Pohl
A1 Martin Pritsch
A1 Kathrin Schanda
A1 Mareike Schimmel
A1 Charlotte Thiels
A1 Stephan Waltz
A1 Gert Wiegand
A1 Banu Anlar
A1 Nina Barisic
A1 Christian Blank
A1 Markus Breu
A1 Philip Broser
A1 Adela Della Marina
A1 Katharina Diepold
A1 Matthias Eckenweiler
A1 Astrid Eisenkölbl
A1 Michael Freilinger
A1 Ursula Gruber-Sedlmayr
A1 Annette Hackenberg
A1 Tobias Iff
A1 Ellen Knierim
A1 Johannes Koch
A1 Georg Kutschke
A1 Steffen Leiz
A1 Grischa Lischetzki
A1 Margherita Nosadini
A1 Alexander Pschibul
A1 Edith Reiter-Fink
A1 Doris Rohrbach
A1 Michela Salandin
A1 Stefano Sartori
A1 Jan-Ulrich Schlump
A1 Johannes Stoffels
A1 Jurgis Strautmanis
A1 Daniel Tibussek
A1 Victoria Tüngler
A1 Norbert Utzig
A1 Markus Reindl
A1 Kevin Rostásy
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