Clinical, Radiologic, and Prognostic Features of Myelitis Associated With Myelin Oligodendrocyte Glycoprotein Autoantibody

被引:271
作者
Dubey, Divyanshu [1 ,2 ]
Pittock, Sean J. [1 ,2 ]
Krecke, Karl N. [3 ]
Morris, Padraig P. [3 ]
Sechi, Elia [1 ]
Zalewski, Nicholas L. [1 ]
Weinshenker, Brian G. [1 ]
Shosha, Eslam [1 ]
Lucchinetti, Claudia F. [1 ]
Fryer, James P. [1 ]
Lopez-Chiriboga, A. Sebastian [1 ,2 ]
Chen, John C. [1 ,4 ]
Jitprapaikulsan, Jiraporn [2 ]
McKeon, Andrew [1 ,2 ]
Gadoth, Avi [1 ]
Keegan, B. Mark [1 ]
Tillema, Jan-Mendelt [1 ]
Naddaf, Elie [1 ]
Patterson, Marc C. [1 ]
Messacar, Kevin [5 ]
Tyler, Kenneth L. [6 ]
Flanagan, Eoin P. [1 ,2 ]
机构
[1] Mayo Clin, Coll Med, Dept Neurol, Rochester, MN USA
[2] Mayo Clin, Coll Med, Dept Lab Med & Pathol, Rochester, MN USA
[3] Mayo Clin, Coll Med, Dept Radiol, Div Neuroradiol, Rochester, MN USA
[4] Mayo Clin, Coll Med, Dept Ophthalmol, Rochester, MN USA
[5] Univ Colorado, Sch Med, Dept Pediat, Aurora, CO USA
[6] Univ Colorado, Sch Med, Dept Neurol, Aurora, CO USA
关键词
ACUTE FLACCID MYELITIS; NEUROMYELITIS-OPTICA; MULTIPLE-SCLEROSIS; SPECTRUM; ANTIBODIES; ENCEPHALOMYELITIS; DISORDERS; DIAGNOSIS; CHILDREN; OUTCOMES;
D O I
10.1001/jamaneurol.2018.4053
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
IMPORTANCE Recognizing the characteristics of myelin oligodendrocyte glycoprotein autoantibody (MOG-IgG) myelitis is essential for early accurate diagnosis and treatment. OBJECTIVE To evaluate the clinical, radiologic, and prognostic features of MOG-IgG myelitis and compare with myelitis with aquaporin-4-IgG (AQP4-IgG) and multiple sclerosis (MS). DESIGN, SETTING, AND PARTICIPANTS We retrospectively identified 199 MOG-IgG-positive Mayo Clinic patients from January 1, 2000, through December 31, 2017, through our neuroimmunology laboratory. Fifty-four patients met inclusion criteria of (1) clinical myelitis; (2) MOG-IgG positivity; and (3) medical records available. We excluded 145 patients without documented myelitis. Myelitis of AQP4-IgG (n = 46) and MS (n = 26) were used for comparison. MAIN OUTCOMES AND MEASURES Outcome variables included modified Rankin score and need for gait aid. A neuroradiologist analyzed spine magnetic resonance imaging of patients with MOG-IgG and control patients blinded to diagnosis. RESULTS Of 54 included patients with MOG-IgG myelitis, the median age was 25 years (range, 3-73 years) and 24 were women (44%). Isolated transverse myelitis was the initial manifestation in 29 patients (54%), and 10 (19%) were initially diagnosed as having viral/postviral acute flaccid myelitis. Cerebrospinal fluid-elevated oligoclonal bands occurred in 1 of 38 (3%). At final follow-up (median, 24 months; range, 2-120 months), 32 patients (59%) had developed 1 or more relapses of optic neuritis (n = 31); transversemyelitis (n = 7); or acute disseminated encephalomyelitis (n = 1). Clinical features favoring MOG-IgG myelitis vs AQP4-IgG or MS myelitis included prodromal symptoms and concurrent acute disseminated encephalomyelitis. Magnetic resonance imaging features favoring MOG-IgG over AQP4-IgG or MS myelitis were T2-signal abnormality confined to gray matter (sagittal line and axial H sign) and lack of enhancement. Longitudinally extensive T2 lesions were of similar frequency in MOG-IgG and AQP4-IgG myelitis (37 of 47 [79%] vs 28 of 34 [82%]; P = .52) but not found in MS. Multiple spinal cord lesions and conus involvement were more frequent with MOG-IgG than AQP4-IgG but not different from MS. Wheelchair dependence at myelitis nadir occurred in one-third of patients with MOG-IgG and AQP4-IgG but never with MS, although patients with MOG-IgG myelitis recovered better than those with AQP4-IgG. CONCLUSIONS AND RELEVANCE Myelitis is an early manifestation of MOG-IgG-related disease and may have a clinical phenotype of acute flaccid myelitis. We identified a variety of clinical and magnetic resonance imaging features that may help clinicians identify those at risk in whom MOG-IgG should be tested.
引用
收藏
页码:301 / 309
页数:9
相关论文
共 36 条
[1]   Motor neuron pathology in experimental autoimmune encephalomyelitis:: studies in THY1-YFP transgenic mice [J].
Bannerman, PG ;
Hahn, A ;
Ramirez, S ;
Morley, M ;
Bönnemann, C ;
Yu, S ;
Zhang, GX ;
Rostami, A ;
Pleasure, D .
BRAIN, 2005, 128 :1877-1886
[2]   Neuromyelitis optica spectrum disorders with antibodies to myelin oligodendrocyte glycoprotein or aquaporin-4: Clinical and paraclinical characteristics in Algerian patients [J].
Bouzar, Melissa ;
Daoudi, Smail ;
Hattab, Samira ;
Bouzar, Amel A. ;
Deiva, Kumaran ;
Wildemann, Brigitte ;
Reindl, Markus ;
Jarius, Sven .
JOURNAL OF THE NEUROLOGICAL SCIENCES, 2017, 381 :240-244
[3]   MOG antibody-related disorders: common features and uncommon presentations [J].
Cobo-Calvo, Alvaro ;
Ruiz, Anne ;
D'Indy, Hyacintha ;
Poulat, Anne-Lise ;
Carneiro, Maryline ;
Philippe, Nicolas ;
Durand-Dubief, Francoise ;
Deiva, Kumaran ;
Vukusic, Sandra ;
Desportes, Vincent ;
Marignier, Romain .
JOURNAL OF NEUROLOGY, 2017, 264 (09) :1945-1955
[4]   Cerebrospinal fluid oligoclonal bands in multiple sclerosis and clinically isolated syndromes: a meta-analysis of prevalence, prognosis and effect of latitude [J].
Dobson, Ruth ;
Ramagopalan, Sreeram ;
Davis, Angharad ;
Giovannoni, Gavin .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2013, 84 (08) :909-914
[5]  
Environment CDoPHa, STAND CAS DEF AC FLA
[6]   Epidemiology of Aquaporin-4 Autoimmunity and Neuromyelitis Optica Spectrum [J].
Flanagan, Eoin P. ;
Cabre, Philippe ;
Weinshenker, Brian G. ;
St Sauver, Jennifer ;
Jacobson, Debra J. ;
Majed, Masoud ;
Lennon, Vanda A. ;
Lucchinetti, Claudia F. ;
McKeon, Andrew ;
Matiello, Marcelo ;
Kale, Nilifur ;
Wingerchuk, Dean M. ;
Mandrekar, Jay ;
Sagen, Jessica A. ;
Fryer, James P. ;
Robinson, Angala Borders ;
Pittock, Sean J. .
ANNALS OF NEUROLOGY, 2016, 79 (05) :775-783
[7]   Discriminating Long Myelitis of Neuromyelitis Optica from Sarcoidosis [J].
Flanagan, Eoin P. ;
Kaufmann, Timothy J. ;
Krecke, Karl N. ;
Aksamit, Allen J. ;
Pittock, Sean J. ;
Keegan, B. Mark ;
Giannini, Caterina ;
Weinshenker, Brian G. .
ANNALS OF NEUROLOGY, 2016, 79 (03) :437-447
[8]   Short Myelitis Lesions in Aquaporin-4-IgG-Positive Neuromyelitis Optica Spectrum Disorders [J].
Flanagan, Eoin P. ;
Weinshenker, Brian G. ;
Krecke, Karl N. ;
Lennon, Vanda A. ;
Lucchinetti, Claudia F. ;
McKeon, Andrew ;
Wingerchuk, Dean M. ;
Shuster, Elizabeth A. ;
Jiao, Yujuan ;
Horta, Erika S. ;
Pittock, Sean J. .
JAMA NEUROLOGY, 2015, 72 (01) :81-87
[9]   A clinical approach to diagnosis of autoimmune encephalitis [J].
Graus, Francesc ;
Titulaer, Maarten J. ;
Balu, Ramani ;
Benseler, Susanne ;
Bien, Christian G. ;
Cellucci, Tania ;
Cortese, Irene ;
Dale, Russell C. ;
Gelfand, Jeffrey M. ;
Geschwind, Michael ;
Glaser, Carol A. ;
Honnorat, Jerome ;
Hoeftberger, Romana ;
Iizuka, Takahiro ;
Irani, Sarosh R. ;
Lancaster, Eric ;
Leypoldt, Frank ;
Pruess, Harald ;
Rae-Grant, Alexander ;
Reindl, Markus ;
Rosenfeld, Myrna R. ;
Rostasy, Kevin ;
Saiz, Albert ;
Venkatesan, Arun ;
Vincent, Angela ;
Wandinger, Klaus-Peter ;
Waters, Patrick ;
Dalmau, Josep .
LANCET NEUROLOGY, 2016, 15 (04) :391-404
[10]  
Greenberg Benjamin M, 2011, Continuum (Minneap Minn), V17, P733, DOI 10.1212/01.CON.0000403792.36161.f5