Jain Rajendra Singh, Jain Deepak, Murarka Sourabh, Vyas Arvind, Sharma Bhawna, Srivastava Trilochan, Kumar Kamlesh, Jain Yavnika, Rao Kavya, Agrawal Jitesh, Tejwani Shankar
Department of Neurology, University SMS Medical College, Jaipur, Rajasthan, India.
NIMS Medical College, Jaipur, Rajasthan, India.
Ann Indian Acad Neurol. 2022 Mar-Apr;25(2):246-255. doi: 10.4103/aian.aian_860_21. Epub 2022 Feb 7.
More and more cases of myelin oligodendrocyte glycoprotein (MOG) antibody are being diagnosed with the availability of laboratory tests helping us to know the differing patterns from AQP-4 antibody disease and we need to understand the natural course, treatment, and prognosis in a better way.
Neuromyelitis optica spectrum disorder (NMOSD) and anti-MOG syndromes are immune-mediated inflammatory demyelinating conditions of the central nervous system (CNS) that mainly involve the optic nerves and the spinal cord. We conducted this study to compare demographic, clinical, laboratory, and radiological features of AQP-4 antibody and MOG antibody positive patients.
A single-centre retrospective observational study from a large tertiary care university centre of Northwest India conducted during 2019--2021. We screened all patients presenting with acute CNS demyelinating attacks and recruited total 47 patients of which 25 were positive for AQP4 antibody and 22 were positive for MOG antibody. No patient tested positive for both antibodies. Data were collected using a standardized format including demographic, clinical, laboratory, and neuroimaging data.
In our study, total 47 patients were included, amongst which 25 patients were AQP4 antibody and 22 patients were MOG antibody positive. Though there was no gender preponderance, pediatric patients were more frequently affected in MOG antibody positive group. In AQP-4 antibody positive patients, myelitis was most common presenting clinical feature followed by optic neuritis (ON), simultaneous ON with myelitis, and brainstem syndrome. In MOG antibody positive group, myelitis was the commonest phenotype followed by ON, brainstem syndrome, and cerebral syndrome. The neuroimaging revealed involvement of medulla mainly area postrema, cervicodorsal spinal cord and extension of cervical lesion up to brainstem more commonly in AQP4 antibody group, on the other hand involvement of upper brainstem (midbrain and pons), cortex, and conus was more common in MOG antibody group.
We have made an attempt to find differentiating features in AQP-4 vs. MOG antibody positive cases but they were of no statistically significance value as the numbers were small. Further larger studies may prove helpful in planning better strategies in two groups.
随着实验室检测手段的出现，越来越多的髓鞘少突胶质细胞糖蛋白（MOG）抗体病例得以诊断，这有助于我们了解其与水通道蛋白4（AQP-4）抗体疾病不同的模式，我们需要更好地了解其自然病程、治疗方法和预后情况。
视神经脊髓炎谱系障碍（NMOSD）和抗MOG综合征是免疫介导的中枢神经系统（CNS）炎性脱髓鞘疾病，主要累及视神经和脊髓。我们开展这项研究以比较AQP-4抗体阳性和MOG抗体阳性患者的人口统计学、临床、实验室及影像学特征。
在印度西北部一所大型三级医疗大学中心于2019年至2021年期间进行的一项单中心回顾性观察研究。我们筛查了所有出现急性中枢神经系统脱髓鞘发作的患者，共招募了47例患者，其中25例AQP4抗体阳性，22例MOG抗体阳性。没有患者两种抗体均呈阳性。使用标准化表格收集数据，包括人口统计学、临床、实验室及神经影像学数据。
在我们的研究中，共纳入47例患者，其中25例为AQP4抗体阳性，22例为MOG抗体阳性。虽然没有性别优势，但MOG抗体阳性组中儿童患者更常受累。在AQP-4抗体阳性患者中，脊髓炎是最常见的临床表现，其次是视神经炎（ON）、同时发生的ON与脊髓炎以及脑干综合征。在MOG抗体阳性组中，脊髓炎是最常见的表型，其次是ON、脑干综合征和脑综合征。神经影像学显示，AQP4抗体组中延髓主要是最后区、颈胸段脊髓受累以及颈部病变延伸至脑干更为常见，另一方面，MOG抗体组中脑桥上段（中脑和脑桥）、皮质和圆锥受累更为常见。
我们试图找出AQP-4抗体阳性与MOG抗体阳性病例的鉴别特征，但由于数量较少，这些特征无统计学意义。进一步的大规模研究可能有助于为两组制定更好的策略。
