Differences in clinical features, disease outcomes and imaging features of demyelinating syndrome after MOG antibody therapy
Authors: Li Baizhu , Shang Xiuli 
Published: March 2023

Objective: To strengthen the clinicians' understanding of the clinical characteristics of patients with negative MOGADD antibody. Methods: The clinical data of 23 MOGADD patients with antibody negative conversion who were hospitalized in the Department of Neurology, the First Affiliated Hospital of China Medical University in Shenyang, Liaoning Province from March 2020 to August 2022 were retrospectively analyzed. The general situation, clinical characteristics, laboratory tests, imaging data, antibodies, treatment and follow-up of the patients were analyzed and summarized. Results: The clinical data of 23 patients with MOGADD were retrospectively analyzed. Most of the patients were adult women, and the onset was vision loss. For the 9 MOGAD patients who turned negative after MOGAD treatment (98.9±26.2 days), the treatment time for the antibody turned negative in the earliest one month and the most recent four months was much shorter than that for the 14 persistent MOGAD positive patients (146.7±27.8 days) (p＜ 0.001, statistically significant difference) suggested that the MOGAD therapy-negative group recovered faster than the MOGAD persistently positive group. The treatment time of MOGADD patients with different titers was inconsistent (p＜0.001, the difference was statistically significant) suggested that the higher the titer in the MOGAD treatment negative group, the later the antibody turned negative, and the higher the titer in the persistent MOGAD positive group, the longer the treatment duration. MOGADD patients had increased cerebrospinal fluid chloride (p＜0.05, the difference was statistically significant)suggested that compared with the MOGAD persistent positive group, the increase of cerebrospinal fluid protein was more common in the MOGAD who turned negative after MOGAD treatment, and the MOGAD persistent positive group had more increased cerebrospinal fluid chloride. In the MOGAD treatment negative group, there were multiple long T2 signal shadows in the head (6/9 cases) and multiple short-segment lesions in the spinal cord MRI, while in the MOGAD continuous positive group, there were multiple patchy long T2 signal shadows and more common in the pons (3/14 cases), and most of the spinal cord MRI of the patients were diffuse long segment and single lesion (p＜0.05, the difference was statistically significant). Therefore, it is concluded that, different from the long segment and single lesion in the spinal cord MRI of the MOGAD continuous positive group, the head MRI lesions of the MOGAD treatment negative group are mostly in the pons and the spinal cord lesions are mostly short segment and multiple lesions. Among the 23 MOGAD patients in this study, 14 (14/23 cases) recurs after MOGAD treatment. The number of MOGAD negative group (1/9 cases) was much less than that of MOGAD persistent positive group (13/14 cases) (p＜0.001, the difference was statistically significant), which suggested that the recurrence rate in the MOGAD who turned negative after MOGAD treatment (11.1%) was much lower than that in the MOGAD who remained positive (92.9%). Conclusion: Compared with antibody-positive patients, antibody-negative MOGADD patients have their own clinical and imaging characteristics, low recurrence rate and good prognosis.