Overlaps of MS with NMO and anti-MOG

[frodo]

An Attempt to Subclassify and Understand Further the MS/NMOSD “Overlap” Syndromes and Beyond

https://n.neurology.org/content/94/15_S ... 6.abstract

Abstract

Objective: An attempt to define and understand better patients who had overlap features between multiple sclerosis (MS), neuromyelitis-optica spectrum disorders (NMOSD), MOG-IgG associated diseases (MOGAD) and atypical inflammatory disorders of the central nervous system (AID-CNS) which may mimic either one.

Background: Although that diagnostic criteria for MS and NMOSD exist and recently has been proposed for MOGAD, the principal diagnostic criterion in their differential is the serology (antibody-status). However, a significant number of cases show overlap features between MS and the antibody-associated diseases or AID-CNS disorders resulting in diagnostic and therapeutic challenges.

Design/Methods: We have studied patients from our MS and NMO/MOGSD cohorts who had overlap features defined as sharing at least two of the clinical, imaging and/or serologic phenotypes of either diagnostic category and patients with AID-CNS who were suggestive of either MS or NMO/MOGSD, but were seronegative and didn’t fulfill any diagnostic criteria (N:31).

Results: Based on the imaging (MRI), clinical, serologic and immunologic (CSF) phenotypes there were 31 overlap cases who were subclassified in four patterns:

Pattern 1: Clinical and imaging phenotypes consistent with MS who were seropositive for AQP4-IgG & MOG-IgG on repeated testing (N:2).

Pattern 2: Clinical and/or imaging phenotypes suggestive of NMOSD, who were seronegative for AQP4-IgG & MOG-IgG on repeated testing and/or with CSF consistent with MS (N:8).

Pattern 3: Clinical and/or imaging phenotypes who shared features suggestive of both MS and NMOSD with either serology (N:17).

Pattern 4: Atypical/unclassifiable seronegative brainstem inflammatory disorders(N:4).

Conclusions: The results of our observational study are suggestive that a significant number of cases share clinical, imaging and serologic features of both MS and NMOSD/MOG-Ab-AD that may be subclassified as overlap cases. Another subgroup with atypical features that may be associated with yet unidentified auto-antibodies also emerged with each having its diagnostic and therapeutic consequences.