MOG Associated Disease

What is MOG associated disease?

It is an inflammatory condition of central nervous system, somewhat like MS and neuromyelitis optica spectrum disorder, caused by an autoantibody (anti-MOG) against brain cells.

 

What is the underlying problem in this condition?

MOG is a protein on the surface of a type of brain cells called oligodendrocytes. In this condition, antibodies against MOG protein are detected in patient’s serum. These antibodies target the outermost layer of myelin, which triggers an inflammatory response leading to destruction of myelin or demyelination. Unlike MS, astrocytes are relatively spared and there is less axonal damage.

 

How common is MOG associated disease?

It is a rare disease (2-3 cases per 100,000), but affects women more than men.

 

What type of clinical problems MOG associated disease may cause?

-Acute demyelinating encephalomyelitis (ADEM): Encephalopathy and demyelination type lesions in the brain and spinal cord.

-Myelitis

-Cerebral cortical encephalitis

-Bilateral optic neuritis

-Brainstem and cerebellar syndrome

 

How is MOG associated disease diagnosed?

1. MRI brain, orbits, and/or spinal cord revealing typical lesions
2. Serum cell-based assay to check for anti-MOG antibodies. A low positive titer is considered false positive. High positive titer (1:1000 or greater) can help make the diagnosis.
3. CSF oligoclonal bands are less common in MOG disease than MS.

 

How is MOG associated disease is treated?

Acute attacks are treated with steroids (1g IV per day for 3-5 days), followed by an oral tapering dose of prednisone. Prednisone 40mg daily can be tapered off in 4-6 weeks. In more severe cases, plasmapheresis or plasma exchange therapy may also help.

Patients are not started on maintenance therapy right away as many patients do not have any recurrence. If needed, IV Ig (1 g/kg/month) or tocilizumab can be used. Other meds that can be used to control the disease are rituximab, azathioprine, and mycophenolate mofetil.

 

Where can I get more information about MOG associated disease?

American Academy of Neurology

National Institute of Health

Mayo Clinic

Cleveland Clinic