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MOG encephalomyelitis: international recommendations on diagnosis and antibody testing

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Item Type:Review
Title:MOG encephalomyelitis: international recommendations on diagnosis and antibody testing
Creators Name:Jarius, S. and Paul, F. and Aktas, O. and Asgari, N. and Dale, R.C. and de Seze, J. and Franciotta, D. and Fujihara, K. and Jacob, A. and Kim, H.J. and Kleiter, I. and Kümpfel, T. and Levy, M. and Palace, J. and Ruprecht, K. and Saiz, A. and Trebst, C. and Weinshenker, B.G. and Wildemann, B.
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.
Keywords:Myelin Oligodendrocyte Glycoprotein (MOG) Antibodies, Consensus Recommendations, Diagnosis, Antibody Testing, Multiple Sclerosis (MS), Neuromyelitis Optica Spectrum Disorders (NMOSD), Optic Neuritis (ON), Myelitis, Animals
Source:Journal of Neuroinflammation
Publisher:BioMed Central
Page Range:134
Date:3 May 2018
Official Publication:https://doi.org/10.1186/s12974-018-1144-2
PubMed:View item in PubMed

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