Onset at the age of 12! A primary school boy was so frightened that he immediately took the child to the ophthalmologist because his vision in his left eye suddenly became blurry, and the doctor initially diagnosed that the optic nerve in his left eye was inflamed. However, soon after returning home, he changed to a seizure in his right eye, and could only see light in severe cases, and even complicated by myelitis and cerebellitis during hospitalization, but fortunately, the condition was finally controlled by medication, and the vision of the left eye recovered to 0.9, but the vision of the right eye was more seriously damaged, and finally only recovered to 0.1.
What’s going on here? After further blood tests, the patient was diagnosed with MOG antibody associated disease (MOGAD), a rare disease, which is not a common optic neuritis. Fortunately, as time passed, the boy had grown into a university student, and during this time, the disease was brought under control through medication, and the vision in his right eye has recently recovered to 0.7.
The symptoms are similar, and antibodies should be tested to help doctors identify the diagnosis:
Multiple sclerosis (MS), pan-neuromyelitis optica (NMOSD) to MOG antibody-related disease (MOGAD).
What are MOG antibody-associated diseases? What is the difference between it and the more well-known multiple sclerosis (MS) and neuromyelitis optica (NMOSD)?
Liao Yizhu, director of the Department of Peripheral Neurology at Taipei Veterans General Hospital, explained that central nervous system immune diseases can currently be classified into three categories: MS, NMOSD and MOGAD, and NMOSD was regarded as a variant subtype of MS in the past, but the prognosis was even worse until the medical community found that AQP4 antibodies in the blood could accurately distinguish between MS and NMOSD. MOG antibody-related disease, a new disease, has been identified in recent years from patients with NMOSD but negative AQP4 antibody, and a group of patients with similar clinical symptoms and positive MOG antibody have been identified through new testing techniques.
The incidence of MOGAD is low, accounting for only 10% of patients with NMOSD, and the average age of onset is relatively young, and the male-to-female ratio is about 1:1. As long as the prognosis of MOG antibody-related diseases is diagnosed and treated early, the prognosis is generally not too bad, but if there is no long-term immunotherapy treatment, it is likely to recurrent optic neuritis or more serious inflammation of the brain and spinal cord. Therefore, how to quickly and correctly diagnose the disease after the onset of the disease has a great impact on the prognosis of patients.
Healing is a race against time!
Clinical experience of neurologists: Patients are advised to send AQP4 antibody & MOG antibody test at their own expense
“The course of treatment for neurological diseases is a race against time, and acute treatment is required immediately after diagnosis. However, once the treatment is started, the antibody concentration in the body will drop significantly, and the MOG antibody test will not be accurate until the negative AQP4 antibody report is received, which will affect the accuracy of the diagnosis.” Therefore, Dr. Liao Yizhu suggested that if patients suspect NMOSD or MOGAD disease, they can send two antibodies for testing at the same time at their own expense, and start treatment with high-dose steroids or plasmapheresis immediately.
Both patients and healthcare professionals should be vigilant and should not neglect any optic nerve related diseases
Most of the typical MOGAD patients have optic neuritis as the first symptom, and they will seek attention to the ophthalmology clinic at the first time, and then be referred to the ophthalmology department of the medical center, and then to the neurology specialist.
In addition to the neurology department is very familiar with this disease, the ophthalmology department of the hospital is also vigilant to such special cases, as long as the change in symptoms is detected, the neurology department can be consulted as soon as possible, or directly help the patient to be sent to an external laboratory at his own expense for AQP4 antibody and MOG antibody testing, which can effectively buy time to speed up the diagnosis and treatment.
廖翊筑 主任
臺北榮民總醫院神經醫學中心周邊神經科
