MOG-Enzephalomyelitis: Internationale Empfehlungen zu Diagnose und Antikörpertestung

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, M. Levy, J. Palace, K. Ruprecht, A. Saiz, C. Trebst, B. G. Weinshenker, B. Wildemann

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Abstrakt

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, and propose for the first time diagnostic criteria for MOG-EM.

Bidragets oversatte titelMOG encephalomyelitis: international recommendations on diagnosis and antibody testing
OriginalsprogTysk
TidsskriftDer Nervenarzt
Vol/bind89
Udgave nummer12
Sider (fra-til)1388–1399
ISSN0028-2804
DOI
StatusUdgivet - dec. 2018

Emneord

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

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