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NMO with MOG Antibody Profile for serum
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- NMO with MOG Antibody Profile for serum
NMO with MOG Antibody Profile for Serum - Comprehensive Medical Guide
- Why is it done?
- Detects antibodies against aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) to diagnose neuromyelitis optica spectrum disorder (NMOSD) and related inflammatory demyelinating diseases
- Differentiates NMOSD from multiple sclerosis (MS) and other central nervous system demyelinating disorders through specific antibody identification
- Evaluates patients presenting with optic neuritis (ON) combined with transverse myelitis (TM), the hallmark features of NMOSD
- Helps classify patients with seronegative demyelinating diseases to identify MOG-antibody-associated disease (MOGAD) as a distinct clinical entity
- Supports prognostic assessment, as AQP4 and MOG seropositivity correlate with disease severity, attack frequency, and treatment response
- Guides immunosuppressive therapy selection, as AQP4-NMOSD requires more aggressive treatment than MOG-associated disease or MS
- Monitors disease activity and treatment efficacy in established cases of NMOSD by tracking antibody titers over time
- Recommended for any patient with clinical features suggestive of NMOSD, particularly those with recurrent ON and/or TM, longitudinally extensive transverse myelitis (LETM), or brain involvement
- Normal Range
- AQP4-IgG Antibody: Negative or <0.5 mmol/L (or <0.05 units/mL depending on assay methodology) is considered negative/normal
- MOG-IgG Antibody: Negative or <0.5 mmol/L (or <1.0 units/mL depending on assay methodology) is considered negative/normal
- Interpretation depends on the specific laboratory methodology (cell-based assay, ELISA, or line immunoassay) - reference ranges should be verified with the testing laboratory
- Negative results: Absence of detectable AQP4 or MOG antibodies indicating no serological evidence of these autoimmune conditions
- Positive results: Presence of AQP4 or MOG antibodies above laboratory-specific cutoff values indicating seropositive disease
- Borderline/Equivocal results: Values near the cutoff may require repeat testing or alternative methodology for confirmation
- Double-seronegative status (both AQP4 and MOG negative) does not exclude NMOSD, as some patients remain seronegative despite clear clinical presentation
- Interpretation
- AQP4-IgG Positive: Confirms diagnosis of AQP4-positive NMOSD; associated with more severe disease, female predominance, and higher relapse rates; requires aggressive immunosuppressive therapy
- MOG-IgG Positive: Indicates MOG-antibody-associated disease (MOGAD); often presents with more acute symptoms; may have better prognosis than AQP4-positive disease but worse than typical MS
- Double-Positive (AQP4 and MOG): Rare occurrence; suggests possible technical artifact or unusual clinical scenario requiring careful clinical correlation
- Both Negative in clinical NMOSD context: Suggests seronegative NMOSD; clinical diagnosis still valid with compatible clinical and radiological findings; approximately 10-20% of NMOSD cases are seronegative
- Low positive titers: May indicate early disease, partial treatment response, or remission; clinical significance requires correlation with disease activity and symptoms
- High positive titers: Generally associated with greater disease activity, higher relapse rates, and need for more intensive immunosuppressive therapy
- Rising titers: May indicate disease exacerbation or inadequate immunosuppressive control; warrants review of treatment regimen
- Falling titers: May indicate treatment efficacy or spontaneous remission; however, persistence of low-level antibodies is common even during remission
- False positives: Rare but may occur; clinical context and repeat testing recommended to confirm seropositivity before initiating long-term immunosuppressive therapy
- False negatives: May occur during remission phase or early acute phase; repeat testing several weeks after acute attack may yield positive results
- Associated Organs
- Central Nervous System (CNS): Primary organ system affected; involves brain, spinal cord, and optic nerves
- Spinal Cord: Frequently affected; characteristically shows longitudinally extensive transverse myelitis (LETM) spanning three or more vertebral segments in AQP4-positive NMOSD
- Optic Nerves: Common site of inflammation; presents as optic neuritis causing monocular visual loss, pain with eye movement, and potential permanent vision impairment if recurrent
- Brain: May be involved in approximately 50% of AQP4-positive NMOSD patients; affects brainstem, hypothalamus, and cerebral white matter
- Brainstem: Inflammation can cause hiccups, nausea, vomiting, and respiratory dysfunction through area postrema involvement
- Hypothalamus: Involvement may lead to syndrome of inappropriate antidiuretic hormone (SIADH), hyperthermia, or narcolepsy-like symptoms
- Associated systemic autoimmune conditions: AQP4-NMOSD frequently co-occurs with systemic lupus erythematosus (SLE), Sjögren syndrome, and other autoimmune disorders affecting multiple organ systems
- Complications affecting organ systems: Severe myelitis can cause permanent paraplegia or tetraplegia; recurrent optic neuritis may result in blindness; brainstem involvement may cause respiratory failure requiring mechanical ventilation
- Follow-up Tests
- Cerebrospinal Fluid (CSF) Analysis: Recommended for newly diagnosed cases; may show pleocytosis, elevated protein, and oligoclonal bands to support inflammatory demyelinating diagnosis
- Magnetic Resonance Imaging (MRI): Brain and spinal cord MRI to visualize demyelinating lesions, assess disease burden, and characterize lesion location and extent
- Optical Coherence Tomography (OCT): To evaluate for optic nerve damage and monitor structural changes in optic nerve head and retinal nerve fiber layer thickness following optic neuritis
- Visual Evoked Potentials (VEP): Electrophysiological testing to assess optic nerve conduction and detect subclinical demyelination in patients with ON
- Autoimmune Panel: Tests for anti-nuclear antibodies (ANA), anti-SSA/Ro, anti-SSB/La, and other autoimmune markers given high frequency of systemic autoimmune disease comorbidity
- Repeat Serum NMO/MOG Testing: Recommended 3-6 weeks after initial negative result if clinical suspicion remains high, as antibodies may be negative during remission or early acute phase
- Periodic Antibody Titer Monitoring: Every 3-6 months in established cases on immunosuppressive therapy to assess treatment response and disease activity trajectory
- Prothrombin Time/INR: If anticoagulation considered for treatment or complication management in high-risk cases
- Immunoglobulin G (IgG) Level: To establish baseline and monitor changes during treatment with plasmapheresis or immunoglobulin therapy
- Comprehensive Metabolic Panel: To monitor kidney and liver function in patients receiving immunosuppressive medications (azathioprine, mycophenolate mofetil, rituximab, etc.)
- Complete Blood Count: To monitor for cytopenias related to immunosuppressive therapy or disease progression
- Fasting Required?
- No, fasting is NOT required for the NMO with MOG Antibody Profile serum test
- Patients may eat and drink normally before blood collection without affecting test results or antibody detection
- No medications require discontinuation specifically for this test; routine medications should be continued as prescribed
- Recent plasmapheresis or intravenous immunoglobulin (IVIG) therapy may transiently lower antibody levels; ideally test should be performed before or at least 2-4 weeks after such treatments
- Blood collection: Standard phlebotomy technique; typically requires 5-10 mL of serum in appropriate collection tube (usually serum separator tube)
- Timing of test collection: Ideally performed during acute phase of symptoms or within 1-2 weeks of symptom onset when antibody levels are highest; useful for initial diagnosis
- Repeat testing: For seronegative cases on initial testing, repeat collection 2-4 weeks after initial test may improve detection; antibodies may emerge during relapse or shortly after acute symptoms
- Sample handling: Serum should be properly separated and handled according to laboratory protocol; samples are typically stable at room temperature for 24 hours or refrigerated for longer periods
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