Clinical characteristics of adult optic neuritis patients with positive serum myelin oligodendrocyte glycoprotein antibody or aquaporin 4 antibody_Chinese Journal of Ocular Fundus Diseases

Authors：

Qiu Huaiyu ¹ , Liu Hongjuan ² , Cheng Kangpeng ³ , Xu Quangang ² , Kang Hao ¹ , Song Honglu ² ,  Zhou Huanfen ² , Wei Shihui ²

1. Department of Ophthalmology, Beijing Chaoyang Hospital of Capital Medical University, Beijing 100020, China;
2. Department of Ophthalmology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China;
3. Department of Ophthalmology, The Eighth Medical Center of Chinese PLA General Hospital, Beijing 100091, China;

Corresponding author：

Zhou Huanfen, Email: zhouzhoueye@163.com

Keywords：

Optic neuritis; Oligodendroglia; Aquaporin 4; Disease attributes; Prognosis

DOI：

10.3760/cma.j.issn.1005-1015.2019.05.008

Video：

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Objective To analyze the clinical features and prognosis of adult optic neuritis patients with positive serum myelin oligodendrocyte glycoprotein antibody (MOG-ON) or aquaporin 4 antibody (AQP4-ON).Methods A retrospective study. From December 2015 to February 2018, in the Beijing Chaoyang Hospital of Capital Medical University and Chinese PLA General Hospital, 162 eyes of 132 patients with positive serum MOG antibody and AQP4 were included in the study. There were 42 MOG-ON patients (49 eyes, 31.8%), 90 AQP4-ON patients (113 eyes, 68.2%). The clinical features of optic neuritis (annual recurrence frequency, incidence of optic disc edema), brain and optic nerve enhanced MRI, serum autoimmune antibodies and cerebrospinal fluid test results were compared between MOG-ON and AQP4-ON patients. All patients were treated with intravenous methylprednisolone sodium succinate in the acute phase and then switched to oral prednisone acetate tablets. The average follow-up time was 15 months. The glucocorticoid dependence, visual prognosis, spinal cord symptoms, and myelitis at the last follow-up were comparatively analyzed between MOG-ON and AQP4-ON patients. The comparison of the count data was performed by χ² test, and the measurement data were compared by t test.Results Compared with AQP4-ON patients, MOG-ON patients had higher annual recurrence frequency (t=3.760, P=0.005), higher incidence of optic disc edema (χ²=14.777, P＜0.001), higher incidence of hormone dependence (χ²=25.496, P＜0.001), and better visual prognosis (χ²=28.759, P＜0.001). MOG-ON patients were more likely to involve the optic nerve, AQP4-ON patients were more likely to involve the optic chiasm and the optic tract. There was a significant difference in the location of lesions between MOG-ON and AQP4-ON patients (χ²= 5.447, P= 0.015). The proportion of AQP4-ON patients with autoimmune antibodies was significantly higher than that of MOG-ON patients (χ² = 20.453, P＜0.001). The results of cerebrospinal fluid test showed that the white blood cell count of patients with MOG-ON and AQP4-ON were within the normal range, but the IgG level of AQP4-ON patients was significantly higher than that of MOG-ON patients (t=8.669, P＜0.001). At the last follow-up, there were 7 and 29 patients of myelitis in MOG-ON and AQP4-ON patients respectively (χ²=3.494, P=0.046).Conclusions The clinical characteristics of MOG-ON were different from AQP4-ON. The incidence of optic disc edema and recurrence rate were higher, but the proportion of autoimmune antibodies was lower. MOG-ON was more likely to show hormone dependence, but the visual prognosis was better. AQP4-ON was easily involved in optic chiasm and optic tract, and the incidence of myelitis was higher.

Citation： Qiu Huaiyu, Liu Hongjuan, Cheng Kangpeng, Xu Quangang, Kang Hao, Song Honglu, Zhou Huanfen, Wei Shihui. Clinical characteristics of adult optic neuritis patients with positive serum myelin oligodendrocyte glycoprotein antibody or aquaporin 4 antibody. Chinese Journal of Ocular Fundus Diseases, 2019, 35(5): 465-469. doi: 10.3760/cma.j.issn.1005-1015.2019.05.008 Copy

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9.	张程祎, 刘峥, 董会卿. 长脊髓脱髓鞘病变的相关抗体及常见疾病MRI特征[J]. 中国神经免疫学和神经病学杂志, 2017, 24(2): 133-138. DOI: 10.3969/j.issn.1006-2963.2017.02.014.Zhang CW, Liu Z, Dong FQ. Antibodies associated with demyelinating lesions of the long spinal cord and MRI features of common diseases[J]. Chin J Neuroimmunol & Neurol, 2017, 24(2): 133-138. DOI: 10.3969/j.issn.1006-2963.2017.02.014.
10.	Kitley J, Waters P, Woodhall M, et al. Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies: a comparative study[J]. JAMA Neurol, 2014, 71(3): 276-283. DOI: 10.1001/jamaneurol.2013.5857.
11.	Sato DK, Callegaro D, Lana-Peixoto MA, et al. Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders[J]. Neurology, 2014, 82(6): 474-481. DOI: 10.1212/WNL.0000000000000101.
12.	Deschamps R, Lecler A, Lamirel C, et al. Etiologies of acute demyelinating optic neuritis: an observational study of 110 patients[J]. Eur J Neurol, 2017, 24(6): 875-879. DOI: 10.1111/ene.13315.
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1. Wingerchuk DM, Banwell B, Bennett JL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders[J]. Neurology, 2015, 85(2): 177-189. DOI: 10.1212/WNL.0000000000001729.
2. 中国免疫学会神经免疫学分会. 中国视神经脊髓炎谱系疾病诊断与治疗指南[J]. 中国神经免疫学和神经病学杂志, 2016, 23(3): 155-166. DOI: 10.3969/j.issn.1006-2963.2016.03.001.Neuroimmunology Society of Chinese Society of Immunology. Guidelines for diagnosis and treatment of pedigree diseases of optic neuromyelitis in China[J]. Chin J Neuroimmunol & Neurol, 2016, 23(3): 155-166. DOI: 10.3969/j.issn.1006-2963.2016.03.001.
3. Reindl M, Jarius S, Rostasy K, et al. Myelin oligodendrocyte glycoprotein antibodies: how clinically useful are they[J]. Curr Opin Neurol, 2017, 30(3): 295-301. DOI: 10.1097/WCO.0000000000000446.
4. Sepulveda M, Armangue T, Martinez-Hernandez E, et al. Clinical spectrum associated with MOG autoimmunity in adults: significance of sharing rodent MOG epitopes[J]. J Neurol, 2016, 263(7): 1349-1360. DOI: 10.1007/s00415-016-8147-7.
5. Jarius S, Ruprecht K, Kleiter I, et al. MOG-IgG in NMO and related disorders: a multicenter study of 50 patients. Part 2: Epidemiology, clinical presentation, radiological and laboratory features, treatment responses, and long-term outcome[J]. J Neuroinflammation, 2016, 13(1): 280. DOI: 10.1186/s12974-016-0718-0.
6. Narayan R, Simpson A, Fritsche K, et al. MOG antibody disease: a review of MOG antibody seropositive neuromyelitis optica spectrum disorder[J]. Mult Scler Relat Disord, 2018, 25: 66-72. DOI: 10.1016/j.msard.2018.07.025.
7. Zhou L, Huang Y, Li H, et al. MOG-antibody associated demyelinating disease of the CNS: a clinical and pathological study in Chinese Han patients[J]. J Neuroimmunol, 2017, 305: 19-28. DOI: 10.1016/j.jneuroim.2017.01.007.
8. 李昕頔, 王化冰, 周衡, 等. 脑脊液MOG抗体阳性的视神经脊髓炎谱系疾病患者的临床特征[J]. 中国神经免疫学和神经病学杂志, 2017, 24(4): 249-255. DOI: 10.3969/j.issn.1006-2963.2017.04.004.Li XD, Wang HB, Zhou H, et al. Clinical features of NMOSD patients with anti-MOG antibodies[J]. Neuroimmunol & Neurol, 2017, 24(4): 249-255. DOI: 10.3969/j.issn.1006-2963.2017.04.004.
9. 张程祎, 刘峥, 董会卿. 长脊髓脱髓鞘病变的相关抗体及常见疾病MRI特征[J]. 中国神经免疫学和神经病学杂志, 2017, 24(2): 133-138. DOI: 10.3969/j.issn.1006-2963.2017.02.014.Zhang CW, Liu Z, Dong FQ. Antibodies associated with demyelinating lesions of the long spinal cord and MRI features of common diseases[J]. Chin J Neuroimmunol & Neurol, 2017, 24(2): 133-138. DOI: 10.3969/j.issn.1006-2963.2017.02.014.
10. Kitley J, Waters P, Woodhall M, et al. Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies: a comparative study[J]. JAMA Neurol, 2014, 71(3): 276-283. DOI: 10.1001/jamaneurol.2013.5857.
11. Sato DK, Callegaro D, Lana-Peixoto MA, et al. Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders[J]. Neurology, 2014, 82(6): 474-481. DOI: 10.1212/WNL.0000000000000101.
12. Deschamps R, Lecler A, Lamirel C, et al. Etiologies of acute demyelinating optic neuritis: an observational study of 110 patients[J]. Eur J Neurol, 2017, 24(6): 875-879. DOI: 10.1111/ene.13315.
13. Akaishi T, Nakashima I, Takeshita T, et al. Different etiologies and prognoses of optic neuritis in demyelinating diseases[J]. J Neuroimmunol, 2016, 299: 152-157. DOI: 10.1016/j.jneuroim.2016.09.007.

Chinese Journal of Ocular Fundus Diseases

Clinical characteristics of adult optic neuritis patients with positive serum myelin oligodendrocyte glycoprotein antibody or aquaporin 4 antibody

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