Distinguishing autoimmune demyelinating diseases from MS
The importance of an accurate diagnosis
While the most common central nervous system (CNS) demyelinating disease is multiple sclerosis (MS), other CNS demyelinating diseases are associated with antibodies to aquaporin-4 (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG-IgG), which drive harmful autoimmune responses. Identifying the antibodies associated with autoimmune CNS demyelinating disease enables diagnostic certainty and implementation of an appropriate treatment regimen, which minimizes the risk of relapse and patient disability.
Neuromyelitis optica spectrum disorders
Neuromyelitis optica (NMO) is an inflammatory, CNS demyelinating disease, characterized by severe relapsing attacks of optic neuritis and transverse myelitis. Unlike attacks associated with MS, NMO attacks commonly spare the brain in the early stages.
The spectrum of NMO was traditionally restricted to the optic nerves and the spinal cord. In 2004, Mayo Clinic scientist Vanda Lennon, M.D., Ph.D., reported an antibody that targets aquaporin-4 (AQP4), the water channel on astrocytes, which is a sensitive and specific biomarker for NMO. Since that discovery, a much broader category called NMO spectrum disorders (NMOSD) has evolved.
Myelin oligodendrocyte glycoprotein (MOG)-opathy
Detection of MOG-IgG is diagnostic of MOG-IgG associated disease (MOGAD), which is a CNS inflammatory demyelinating disease where the clinical phenotype (NMO, optic neuritis, transverse myelitis, acute disseminated encephalomyelitis [ADEM]) may be similar, but the immunopathology (astrocytopathy vs. oligodendrogliopathy) and clinical outcome (worse vs. better) are different. Detection of MOG-IgG also predicts disease relapse.
More importantly, MOGAD is distinct from MS and treated differently, with many MS treatments reported to worsen MOGAD.
By the numbers
of patients with NMOSD are initially misdiagnosed with MS1
of AQP4-IgG-negative patients are positive for MOG-IgG2
probability of second optic neuritis episode within one year of initial attack in AQP4-positive patients3
Ensuring better patient outcomes
Due to significant overlap in the clinical phenotypes, we recommend testing for AQP4-IgG and MOG-IgG at the same time. This synchronized testing method allows for a faster diagnosis and treatment plan decision for your patient.
Elevating outcomes through early detection
Learn more about NMOSD and the critical importance of sensitive and specific AQP4-IgG laboratory testing for early diagnosis and treatment in this “Hot Topic” presentation given by Sean Pittock, M.D.
Similar characteristics, different treatment
FACS: A superior method of testing
Mayo Clinic has developed the only fluorescence activated cell sorting (FACS) live cell-binding assay currently available in the U.S. for antibody detection of AQP4 and MOG. FACS is recommended by international leaders in neuroimmunology for its increased sensitivity and specificity.
Which test should I order?
Learn more about how to order this evaluation at your institution.