In: Journal of Neuroinflammation, 15 (2018), Nr. 134. pp. 1-10. ISSN 1742-2094

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PDF, English Download (440kB) | Lizenz: MOG encephalomyelitis: international recommendations on diagnosis and antibody testing by Jarius, S. ; Paul, F. ; Aktas, O. ; Asgari, N. ; Dale, R. C. ; 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. underlies the terms of Creative Commons Attribution 4.0

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.