2023 Sessions - CMSC Scholar

Cases in Aquaporin-4 Antibody Positive Neuromyelitis Optica Spectrum Disorder and MOG Antibody-Associated Disease

Chair: Eoin Flanagan, MB, BCh (Mayo Clinic)

Aquaporin-4-IgG positive Neuromyelitis Optica Spectrum Disorder (AQP4+NMOSD) and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) are subsets of the central nervous system inflammatory demyelinating diseases and are now recognized as distinct diseases from multiple sclerosis. Given their recent recognition and our evolving understanding of these disorders, a case-based course will be useful for MS providers and neuroimmunologists who attend this course to highlight diagnostic pearls and pitfalls as well the treatment aproach. There will be a particular focus on pediatric MOGAD given approximately half of new MOGAD cases occur in children and we will also focus on updated diagnostic criteria in MOGAD and their application in clinical practice. We will highlight clinical, radiologic and serolgic pearls to AQP4+NMOSD with a focus on the major clinical features, the importance of cell-based assays and the MRI spectrum. In MOGAD we will cover the major clinical syndromes, highlight the novel clinical syndrome of cerebral cortical encephalitis and review its MRI spectrum. We will review the potential for MOG-IgG cell-based assay low-titer false positive results. We will summarize the approach to acute attacks treatments in both AQP4+NMOSD and MOGAD. We will review the attack-prevention options for AQP4+NMOSD including those with class 1 evidence and those that are FDA approved. We will also cover MOGAD attack-prevention treatments which are generally reserved for relapsing disease (as up to 50% are monophasic) and which lack class 1 data with decisions based on retrospective case series, experience from other autoimmune neurologic disorders and expert opinion. Level of Information: Intermediate