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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., Paul, F., Aktas, O., Asgari, N., Dale, R.C., de Seze, J., Franciotta, D., Fujihara, K., Jacob, A., Kim, H.J., Kleiter, I., Kümpfel, T., Levy, M., Palace, J., Ruprecht, K., Saiz, A., Trebst, C., 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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