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MOG antibody associated demyelination and NMOSD
MOG stands for Myelin Oligodendrocyte Glycoprotein. MOG antibodies have recently been reported in some people who have transverse myelitis and/or optic neuritis and/or ADEM (acute disseminated encephalomyelitis) and AQP4 antibody negative NMOSD. However, their discovery is recent and there is much to be learned. MOG antibodies are found on the myelin sheath rather than the astrocyte as in AQP4 antibodies and cause damage to the myelin.
In contrast to typical NMOSD (caused by AQP4 antibodies) up to half of the persons with an episode of demyelination (e.g. optic neuritis) and MOG antibodies often have a ‘one-off’ event and usually recover well from their illness
Treatment of MOG antibody associated disease
Since we are not sure about the natural course of the disease (e.g. what is the risk of disability? Does the disease go into spontaneous remission?) Treatment usually consists of a slow taper of corticosteroids (prednisolone) over 6 months to a year after the first event. If a relapse occurs then additional immunosuppressants (e.g. azathioprine) may need to be used much like we treat AQP4 antibody associated NMOSD.
When to test for MOG Antibodies
- AQP4 antibody negative NMOSD
- Recurrent, bilateral or severe optic neuritis Longitudinal or recurrent transverse myelitis
- ‘Atypical MS’ or other uncharacterized CNS demyelination
- Unexplained ‘encephalitis’ and seizures with brain lesions
Don’t test for MOG
- If typical of relapsing MS
- If AQP4 antibody is present
- If another obvious and definite diagnosis is present
If the test is positive, please refer the patient into one of the NMOSD centres.
If you have any questions regarding diagnosis or management, please refer to the NMOSD service.