Center for Neuroinflammation and Neurotherapeutics, and Multiple Sclerosis Division, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA/Montreal Neurological Institute, McGill University, Montreal, QC, Canada.
Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
Mult Scler. 2022 Oct;28(11):1697-1709. doi: 10.1177/13524585221093789. Epub 2022 May 17.
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is now recognized as distinct from multiple sclerosis (MS).
To evaluate the importance of considering myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin-G (IgG) serology when applying MS diagnostic criteria in children.
Within a prospective cohort of children meeting MS criteria (median follow-up = 6 years, interquartile range (IQR) = 4-9), we measured MOG-IgG in serial archived serum obtained from presentation, and compared imaging and clinical features between seropositive and seronegative participants.
Of 65 children meeting MS criteria (median age = 14.0 years, IQR = 10.9-15.1), 12 (18%) had MOG-IgG at disease onset. Seropositive participants were younger, had brain magnetic resonance imaging (MRI) features atypical for MS, rarely had cerebrospinal fluid (CSF) oligoclonal bands (2/8, 25%), and accumulated fewer T2 lesions over time. On serial samples, 5/12 (42%) were persistently seropositive, 5/12 (42%) became seronegative, and 2/12 (17%) had fluctuating results. All 12 children experienced a disease course different from typical MS.
While children with MOG-IgG can have clinical, CSF, and MRI features conforming to MS criteria, the presence of MOG-IgG is associated with atypical features and predicts a non-MS disease course. Given MOG-IgG seropositivity can wane over time, testing at first attack is of considerable importance for the diagnosis of MOGAD.
髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）现已被认为与多发性硬化症（MS）不同。
评估在应用 MS 诊断标准时考虑髓鞘少突胶质细胞糖蛋白（MOG）-免疫球蛋白 G（IgG）血清学的重要性。
在符合 MS 标准的儿童前瞻性队列中（中位随访时间为 6 年，四分位间距[IQR]为 4-9 年），我们在发病时检测了连续存档的血清中的 MOG-IgG，并比较了血清阳性和血清阴性参与者的影像学和临床特征。
在符合 MS 标准的 65 名儿童中（中位年龄为 14.0 岁，IQR 为 10.9-15.1 岁），12 名（18%）在发病时出现 MOG-IgG。血清阳性参与者更年轻，脑部磁共振成像（MRI）特征不典型，很少有脑脊液（CSF）寡克隆带（2/8，25%），并且随着时间的推移，T2 病变积累更少。在连续样本中，5/12（42%）持续血清阳性，5/12（42%）转为血清阴性，2/12（17%）结果波动。所有 12 名儿童的疾病过程均与典型 MS 不同。
虽然 MOG-IgG 患儿可能具有符合 MS 标准的临床、CSF 和 MRI 特征，但 MOG-IgG 的存在与不典型特征相关，并预测为非 MS 疾病过程。鉴于 MOG-IgG 阳性可能随时间减弱，在首次发作时进行检测对于 MOGAD 的诊断具有重要意义。
