Diagnostic implications of MOG-IgG detection in sera and cerebrospinal fluids

• DOI: 10.1093/brain/awad122
• Publication Date: 2023-04-16T06:59:38Z
• Authors: Yuki Matsumoto; Kimihiko Kaneko; Toshiyuki Takahashi; Yoshiki Takai; Chihiro Namatame; Hiroshi Kuroda; Tatsuro Misu; Kazuo Fujihara; Masashi Aoki
• Keywords: Aquaporin 4; Cross-Sectional Studies; Multiple Sclerosis; Optic Neuritis; Immunoglobulin G; Neuromyelitis Optica; Humans; Encephalitis; Myelin-Oligodendrocyte Glycoprotein; Myelitis; 3. Good health; Autoantibodies

The spectrum of MOG-IgG-associated disease (MOGAD) includes optic neuritis (ON), myelitis (MY), acute disseminated encephalomyelitis (ADEM), brainstem encephalitis, cerebral cortical encephalitis (CE) and AQP4-IgG-negative neuromyelitis optica disorder (NMOSD). In MOGAD, MOG-IgG are usually detected in sera (MOG-IgGSERUM), but there have been some seronegative MOGAD cases with CSF (MOG-IgGCSF), its diagnostic implications remains unclear. this cross-sectional study, we identified patients paired serum sent from all over Japan for testing MOG-IgG. Two investigators blinded to status classified them into suspected (ADEM, CE, NMOSD, ON, MY Others) or not based on the current recommendations. MOG-IgGSERUM MOG-IgGCSF titres were assessed serial 2-fold dilutions determine end point [≥1:128 ≥1:1 (no dilution) considered positive]. We analysed relationship between MOG-IgGSERUM, phenotypes multivariable regression. A total 671 tested [405 99 multiple sclerosis, 48 AQP4-IgG-positive NMOSD 119 other neurological diseases (OND)] before treatment. 133 (33%) MOG-IgG-positive and/or CSF; 94 (23%) double-positive (ADEM 36, CE 15, 8, 9, ON 15 Others 11); 17 (4.2%) serum-restricted-positive 2, 0, 3, 5 4); 22 (5.4%) CSF-restricted-positive 4, 6, 0 7). None sclerosis OND positive two MOG-IgGCSF-positive; specificities 100% [95% confidence interval (CI) 99-100%] 99% (95% CI 97-100%), respectively. Unlike correlation was weak. Multivariable regression analyses revealed associated ADEM, whereas ADEM CE. number needed test diagnose one additional case 13.3 (14.3 2 19.5 infinite 18.5 6.1 Others). terms MOG-IgGSERUM/CSF status, most while including either serum-restricted (13%) CSF-restricted (17%) cases. These statuses independently clinical phenotypes, especially those CSF, suggesting pathophysiologic utility preferential testing. Further studies warranted deduce pathological significance compartmentalized