Vol.:(0123456789) 1 3 Acta Neurologica Belgica https://doi.org/10.1007/s13760-020-01356-9 ORIGINAL ARTICLE Spectrum of anti‑myelin oligodendrocyte glycoprotein antibody (MOG‑Ab)‑associated diseases: an Indian perspective Jasodhara Chaudhuri 1  · Tamoghna Biswas 2  · Gautam Ganguly 1  · Supratim Datta 2  · Alak Pandit 1  · Atanu Biswas 1 Received: 6 February 2020 / Accepted: 6 April 2020 © Belgian Neurological Society 2020 Abstract Myelin oligodendrocyte glycoprotein antibody (MOG-Ab) is involved in the pathogenesis of central nervous system (CNS) demyelination disorders. We aimed to explore the spectrum of MOG-Ab-associated diseases in eastern India. A single-center, prospective observational study was done over a period of 2 years in a tertiary care hospital of eastern India. Patients with CNS demyelination disorders who tested positive for MOG-Ab using live cell-based assay were included in the study; while, those with age less than 1 year, documented preexisting CNS structural lesions, developmental delays or diagnosed multiple sclerosis were excluded. Demographic profle, clinical spectrum, disease course, radiological features as well as response to treatment were analyzed among included patients. Twenty MOG-Ab-positive patients were included (M:F 1:1.85). The median age of symptom onset was 10.5 years. The median follow-up of patients was 13 months. Acute disseminated encepha- lomyelitis (ADEM) was the commonest presentation at frst attack (55%), followed by optic neuritis (ON) (45%). Patients with ADEM had a signifcantly lower age at frst attack (p = 0.025). Monophasic and relapsing disease courses were seen in 45% and 55% patients, respectively. While all patients with only ADEM had a monophasic course, 77.8% with ON had a relapsing course. Among patients who presented with isolated transverse myelitis, 75% had a monophasic course and all had disease confned to the spinal cord. Good response to corticosteroids was seen in majority of participants. Second-line drugs were needed in 55% patients, rituximab being the commonest second-line agent used. 35% patients had signifcant disability (EDSS > 4) at last follow-up. MOG-Ab-associated diseases have diverse clinical phenotypes characterized by age-dependent pattern-specifc courses. Keywords Myelin oligodendrocyte glycoprotein · Encephalomyelitis · Transverse myelitis · Optic neuritis Introduction Myelin oligodendrocyte glycoprotein (MOG), a protein of the immunoglobulin superfamily, expressed exclusively in the central nervous system (CNS), has emerged as a poten- tial target antigen in a signifcant number of diseases asso- ciated with CNS demyelination [1]. MOG-antibody (Ab)- associated demyelination is more common in the young, with almost one-third of children with acquired demyeli- nating syndromes (ADS) being MOG-Ab positive [2]. While the entire clinical spectrum is yet to be understood, MOG autoimmunity has been reported [3–5] to be associated with a wide clinical phenotype including optic neuritis (ON), neuromyelitis optica spectrum disorder (NMOSD, specially AQP4-Ab-negative), acute disseminated encephalomyelitis (ADEM), transverse myelitis (TM), etc. With existing lit- erature being scanty, MOG-Ab-associated disease is still a relatively new entity with controversies surrounding diagno- sis and treatment. We aimed to explore the epidemiological and clinical spectrum of MOG-Ab-associated disease in a tertiary care neurology referral center of eastern India. Methods A hospital-based prospective observational study was con- ducted at the Department of Neuromedicine of Bangur Insti- tute of Neurosciences, Institute of Post Graduate Medical * Jasodhara Chaudhuri jasodharachaudhuri@gmail.com 1 Department of Neuromedicine, Bangur Institute of Neurosciences, 52/1a, Sambhunath Pandit Street, Kolkata 700020, India 2 Department of Pediatrics, Institute of Post Graduate Medical Education and Research, Kolkata, India