Highlights
- •Five-year visual outcome in MOG-IgG-associated disorder (MOGAD) was evaluated.
- •Five-year visual acuity (VA) was better in MOGAD than in anti-AQP4-positive NMOSD.
- •VA swiftly recovered spontaneously or after IVMP in almost all cases with MOGAD.
- •VA may not fully recover in some MOGAD cases with extensive optic nerve lesions.
- •Visual outcome was irrelevant to the level of serum MOG-IgG titer at the onset.
Abstract
Introduction
Optic neuritis (ON) is a major phenotype of clinical attack related to demyelinating
neurological diseases of the central nervous system, including multiple sclerosis
(MS), anti-aquaporin-4 (AQP4) antibody-positive neuromyelitis optica spectrum disorder
(NMOSD), and anti-myelin oligodendrocyte glycoprotein antibody-associated disease
(MOGAD). As the concept of MOGAD is relatively new, the long-term visual outcomes
after ON in MOGAD remains unclear.
Methods
To elucidate the long-term visual prognosis after ON in MOGAD, patients with MOGAD
whose visual acuity were regularly followed for more than 5 years from the onset of
ON were enrolled. Best-corrected visual acuity (BCVA) at nadir in the acute phase
and at 1 and 5 years from onset was evaluated. The data from patients with MOGAD were
compared with those from patients with MS or anti-AQP4-positive NMOSD.
Results
Twenty-three patients (31 ON-involved eyes) with MOGAD, 20 patients (24 ON-involved
eyes) with MS, and 22 patients (24 ON-involved eyes) with anti-AQP4-positive NMOSD
were evaluated. All BCVA at nadir, 1 year, and 5 years from the onset of ON were much
worse in anti-AQP4-positive NMOSD than in MS (p = 0.0024) and MOGAD (p = 0.0014) patients. In MOGAD and anti-AQP4-positive NMOSD, the serum disease-specific
antibody titer was not associated with the subsequent visual prognosis. Visual acuity
had almost fully recovered spontaneously or shortly after initiating acute treatment
in 22 of the 23 patients with MOGAD-ON. The administration of high-dose intravenous
steroid therapy further facilitated early recovery of visual acuity. Meanwhile, a
small fraction of patients with extensive optic nerve lesions involving the chiasma
irreversibly experienced severe visual impairment despite appropriate acute treatment.
Conclusion
Although a small fraction of patients with MOGAD who presented with extensive optic
nerve lesions experienced irreversible severe visual impairment, the long-term visual
outcomes after 5 years from ON in patients with MOGAD were generally as good as that
in patients with MS and much better than that in patients with anti-AQP4-positive
NMOSD.
Graphical abstract
Graphical Abstract
Keywords
Abbreviation:
BCVA (best-corrected visual acuity), IVMP (intravenous methylprednisolone pulse), MOGAD (anti-myelin oligodendrocyte glycoprotein antibody-associated disease), MOG-IgG (anti-myelin oligodendrocyte glycoprotein antibody), MS (multiple sclerosis), AQP4-IgG (anti-aquaporin-4 antibodies), NMOSD (neuromyelitis optica spectrum disorder), ON (optic neuritis), VA (visual acuity)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Multiple Sclerosis and Related DisordersAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Treatment of acute relapses in neuromyelitis optica: steroids alone versus steroids plus plasma exchange.Mult. Scler. 2016; 22 (Optic Neuritis Study Group): 185-192
- Different etiologies and prognoses of optic neuritis in demyelinating diseases.J. Neuroimmunol. 2016; 299: 152-157
- Progressive patterns of neurological disability in multiple sclerosis and neuromyelitis optica spectrum disorders.Sci. Rep. 2020; 10: 13890
- Difference in the source of anti-AQP4-IgG and anti-MOG-IgG antibodies in CSF in patients with neuromyelitis optica spectrum disorder.Neurology. 2021; 97: e1-e12
- Rapid administration of high-dose intravenous methylprednisolone improves visual outcomes after optic neuritis in patients with AQP4-IgG-positive NMOSD.Front. Neurol. 2020; 11: 932
- Clinical outcomes and predictive factors related to good outcomes in plasma exchange in severe attack of NMOSD and long extensive transverse myelitis: case series and review of the literature.Mult. Scler. Relat. Disord. 2017; 13: 93-97
- The course of visual recovery after optic neuritis. Experience of the optic neuritis treatment trial.Ophthalmology. 1994; 101: 1771-1778
- Plasma exchange in severe attacks of neuromyelitis optica.Mult. Scler. Int. 2012; 2012787630
- Diagnosis and treatment of NMO spectrum disorder and MOG-encephalomyelitis.Front. Neurol. 2018; 9: 888
- Myelin oligodendrocyte glycoprotein antibody-positive optic neuritis: clinical characteristics, radiologic clues, and outcome.Am. J. Ophthalmol. 2018; 195: 8-15
- Acute idiopathic optic neuritis: not always benign.Eur. J. Neurol. 2018; 25: 1378-1383
- Myelin oligodendrocyte glycoprotein antibody-associated disorders: toward a new spectrum of inflammatory demyelinating CNS disorders?.Front. Immunol. 2018; 9: 2753
- AQP4-IgG and MOG-IgG related optic neuritis-prevalence, optical coherence tomography findings, and visual outcomes: a systematic review and meta-analysis.Front. Neurol. 2020; 11540156
- MOG-antibody-associated disease is different from MS and NMOSD and should be classified as a distinct disease entity - commentary.Mult. Scler. 2020; 26: 276-278
- Acute optic neuritis: unmet clinical needs and model for new therapies.Neurol. Neuroimmunol. Neuroinflamm. 2015; 2: e135
- Treatment approaches for MOG-Ab-associated demyelination in children.Curr. Treat Options Neurol. 2019; 21: 2
- Antibodies to MOG and AQP4 in adults with neuromyelitis optica and suspected limited forms of the disease.Mult. Scler. 2015; 21: 866-874
- Epidemiology of neuromyelitis optica spectrum disorder and its prevalence and incidence worldwide.Front. Neurol. 2020; 11: 501
- Epidemiologic and clinical characteristics of optic neuritis in Japan.Ophthalmology. 2019; 126: 1385-1398
- MOG-IgG in NMO and related disorders: a multicenter study of 50 patients. Part 3: brainstem involvement - frequency, presentation and outcome.J. Neuroinflammation. 2016; 13: 281
- Neuromyelitis optica: clinical features, immunopathogenesis and treatment.Clin. Exp. Immunol. 2014; 176: 149-164
- Aquaporin-4 and myelin oligodendrocyte glycoprotein autoantibody status predict outcome of recurrent optic neuritis.Ophthalmology. 2018; 125: 1628-1637
- Neuromyelitis optica: evaluation of 871 attacks and 1153 treatment courses.Ann. Neurol. 2016; 79: 206-216
- The prevalence and prognostic value of myelin oligodendrocyte glycoprotein antibody in adult optic neuritis.J. Neurol. Sci. 2019; 396: 225-231
- Comparison of clinical outcomes of transverse myelitis among adults with myelin oligodendrocyte glycoprotein antibody vs aquaporin-4 antibody disease.JAMA Netw. Open. 2019; 2e1912732
- Differential diagnosis of suspected multiple sclerosis: a consensus approach.Mult. Scler. 2008; 14: 1157-1174
- Early high-dose intravenous methylprednisolone is effective in preserving retinal nerve fiber layer thickness in patients with neuromyelitis optica.Graefes. Arch. Clin. Exp. Ophthalmol. 2010; 248: 1777-1785
- MOG antibody-positive, benign, unilateral, cerebral cortical encephalitis with epilepsy.Neurol. Neuroimmunol. Neuroinflamm. 2017; 4: e322
- Myelin oligodendrocyte glycoprotein antibodies: How clinically useful are they?.Curr. Opin. Neurol. 2017; 30: 295-301
- Myelin oligodendrocyte glycoprotein antibodies in neurological disease.Nat. Rev. Neurol. 2019; 15: 89-102
- Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders.Neurology. 2014; 82: 474-481
- The optic nerve.Semin. Neurol. 2009; 29: 29-35
- Establishment of a new sensitive assay for anti-human aquaporin-4 antibody in neuromyelitis optica.Tohoku J. Exp. Med. 2006; 210: 307-313
- Anti-aquaporin-4 antibody is involved in the pathogenesis of NMO: a study on antibody titre.Brain. 2007; 130 (Pt): 1235-1243
- Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.Lancet Neurol. 2018; 17: 162-173
- The diagnosis and treatment of optic neuritis.Dtsch Arztebl. Int. 2015; 112 (quiz 626): 616-625
- International consensus diagnostic criteria for neuromyelitis optica spectrum disorders.Neurology. 2015; 85: 177-189
Article info
Publication history
Published online: August 23, 2021
Accepted:
August 22,
2021
Received in revised form:
August 4,
2021
Received:
June 29,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
