The clinical relevance of <scp>MOG</scp> antibody testing in cerebrospinal fluid
Molly Reynolds, Irene Tan, Kristy Nguyen, Vera Merheb, Fiona X. Z. Lee, Benjamin Trewin, Magdalena Lerch, Snehal Shah, Nigel Wolfe, Katherine Buzzard, Jeannette Lechner‐Scott, Marzena J. Fabis‐Pedrini, Anthony Fok, Nevin John, Chris Kneebone, Con Yiannikas, David A. Brown, Allan G. Kermode, Stephen Reddel, Russell C. Dale, Fabienne Brilot, Sudarshini Ramanathan, the Australasian MOGAD Study Group
Abstract
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is diagnosed by serum MOG-immunoglobulin G (MOG-IgG) in association with typical demyelination. 111/1127 patients with paired CSF/serum samples were seropositive for MOG-IgG. Only 7/1016 (0.7%) seronegative patients had CSF-restricted MOG-IgG. While 3/7 patients had longitudinally extensive transverse myelitis, four had a confirmed alternate diagnosis (three multiple sclerosis, one CNS vasculitis). In a national referral setting, CSF-restricted MOG-IgG had a low sensitivity (2.63%, 95%CI 0.55-7.50%) and low positive predictive value (1.97%, 95%CI 0.45-8.13%). We strongly recommend serum as the preferred diagnostic biospecimen, and urge caution in the interpretation of CSF-restricted MOG-IgG in patients without clinico-radiological features consistent with MOGAD.