MOG encephalomyelitis: International recommendations on diagnosis and antibody testing

S. Jarius, F. Paul, O. Aktas, N. Asgari, R. C. Dale, J. de Seze, D. Franciotta, K. Fujihara, A. Jacob, H. J. Kim, I. Kleiter, T. Kümpfel, Michael Levy, J. Palace, K. Ruprecht, A. Saiz, C. Trebst, B. G. Weinshenker, B. Wildemann

Research output: Contribution to journalReview article

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.

Original languageEnglish (US)
Article number134
JournalJournal of Neuroinflammation
Volume15
Issue number1
DOIs
StatePublished - May 3 2018

Fingerprint

Encephalomyelitis
Immunoglobulin G
Antibodies
Multiple Sclerosis
Acute Disseminated Encephalomyelitis
Aquaporin 4
Neuromyelitis Optica
Predictive Value of Tests
Myelitis
Optic Neuritis
Encephalitis
Diagnostic Errors
Autoantibodies
Brain Stem
Biomarkers
Physicians

Keywords

  • Antibody testing
  • Consensus recommendations
  • Diagnosis
  • Multiple sclerosis (MS)
  • Myelin oligodendrocyte glycoprotein (MOG) antibodies
  • Neuromyelitis optica spectrum disorders (NMOSD)
  • Optic neuritis (ON), Myelitis

ASJC Scopus subject areas

  • Neuroscience(all)
  • Immunology
  • Neurology
  • Cellular and Molecular Neuroscience

Cite this

Jarius, S., Paul, F., Aktas, O., Asgari, N., Dale, R. C., de Seze, J., ... Wildemann, B. (2018). MOG encephalomyelitis: International recommendations on diagnosis and antibody testing. Journal of Neuroinflammation, 15(1), [134]. https://doi.org/10.1186/s12974-018-1144-2

MOG encephalomyelitis : International recommendations on diagnosis and antibody testing. / 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, Michael; Palace, J.; Ruprecht, K.; Saiz, A.; Trebst, C.; Weinshenker, B. G.; Wildemann, B.

In: Journal of Neuroinflammation, Vol. 15, No. 1, 134, 03.05.2018.

Research output: Contribution to journalReview article

Jarius, S, Paul, F, Aktas, O, Asgari, N, Dale, RC, de Seze, J, Franciotta, D, Fujihara, K, Jacob, A, Kim, HJ, Kleiter, I, Kümpfel, T, Levy, M, Palace, J, Ruprecht, K, Saiz, A, Trebst, C, Weinshenker, BG & Wildemann, B 2018, 'MOG encephalomyelitis: International recommendations on diagnosis and antibody testing', Journal of Neuroinflammation, vol. 15, no. 1, 134. https://doi.org/10.1186/s12974-018-1144-2
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, Michael ; Palace, J. ; Ruprecht, K. ; Saiz, A. ; Trebst, C. ; Weinshenker, B. G. ; Wildemann, B. / MOG encephalomyelitis : International recommendations on diagnosis and antibody testing. In: Journal of Neuroinflammation. 2018 ; Vol. 15, No. 1.
@article{31135c98810042768d833596c8eb447d,
title = "MOG encephalomyelitis: International recommendations on diagnosis and antibody testing",
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 = "Antibody testing, Consensus recommendations, Diagnosis, Multiple sclerosis (MS), Myelin oligodendrocyte glycoprotein (MOG) antibodies, Neuromyelitis optica spectrum disorders (NMOSD), Optic neuritis (ON), Myelitis",
author = "S. Jarius and F. Paul and O. Aktas and N. Asgari and Dale, {R. C.} and {de Seze}, J. and D. Franciotta and K. Fujihara and A. Jacob and Kim, {H. J.} and I. Kleiter and T. K{\"u}mpfel and Michael Levy and J. Palace and K. Ruprecht and A. Saiz and C. Trebst and Weinshenker, {B. G.} and B. Wildemann",
year = "2018",
month = "5",
day = "3",
doi = "10.1186/s12974-018-1144-2",
language = "English (US)",
volume = "15",
journal = "Journal of Neuroinflammation",
issn = "1742-2094",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - MOG encephalomyelitis

T2 - International recommendations on diagnosis and antibody testing

AU - Jarius, S.

AU - Paul, F.

AU - Aktas, O.

AU - Asgari, N.

AU - Dale, R. C.

AU - de Seze, J.

AU - Franciotta, D.

AU - Fujihara, K.

AU - Jacob, A.

AU - Kim, H. J.

AU - Kleiter, I.

AU - Kümpfel, T.

AU - Levy, Michael

AU - Palace, J.

AU - Ruprecht, K.

AU - Saiz, A.

AU - Trebst, C.

AU - Weinshenker, B. G.

AU - Wildemann, B.

PY - 2018/5/3

Y1 - 2018/5/3

N2 - 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.

AB - 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.

KW - Antibody testing

KW - Consensus recommendations

KW - Diagnosis

KW - Multiple sclerosis (MS)

KW - Myelin oligodendrocyte glycoprotein (MOG) antibodies

KW - Neuromyelitis optica spectrum disorders (NMOSD)

KW - Optic neuritis (ON), Myelitis

UR - http://www.scopus.com/inward/record.url?scp=85046478031&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046478031&partnerID=8YFLogxK

U2 - 10.1186/s12974-018-1144-2

DO - 10.1186/s12974-018-1144-2

M3 - Review article

C2 - 29724224

AN - SCOPUS:85046478031

VL - 15

JO - Journal of Neuroinflammation

JF - Journal of Neuroinflammation

SN - 1742-2094

IS - 1

M1 - 134

ER -