CLINICAL AND RADIOLOGICAL DIFFERENCES BETWEEN MYELIN OLIGODENDROCYTE GLYCOPROTEIN ASSOCIATED DISEASE (MOGAD) AND AQUAPORIN4 NEUROMYELITIS OPTICA SPECTRUM DISORDERS (AQP4 NMOSD)
Main Article Content
Keywords
Anti Aquaporin-4, MOGAD, Myelin Oligodendrocyte Glycoprotein, Myelitis, NMOSD, Optic Neuritis
Abstract
OBJECTIVE
To assess the Clinical and Radiological differences between Myelin Oligodendrocyte Glycoprotein Associated Disease (MOGAD) and Aquaporin4 Neuromyelitis Optica Spectrum Disorders (AQP4 NMOSD).
METHODOLOGY
The Department of Neurology at the Jinnah Postgraduate Medical Centre (JPMC), Karachi, conducted this prospective cross-sectional study on 55 patients of age 13-55 years from either of gender, who had either anti-MOG or anti-AQP4 antibodies positive and fulfilled NMOSD criteria. Patients excluded from the study included those diagnosed with multiple sclerosis, tuberculosis, systemic lupus erythematosus (SLE), sarcoidosis, and vascular disorders and patients lost to follow-up. Differences in MOGAD and Anti-AQP4-IgG+ NMOSD were stated. The data was interpreted using SPSS version 26.
RESULTS
The mean age of the participants was 33.15±10.42 years. The gender distribution showed the predominance of females, constituting 67.3% of the sample, with males accounting for the remaining 32.7%. In patients who were ANTI MOG AB positive (n=11) and ANTI AQP-4 AB positive (n=29), the clinical features and symptoms were; cervical myelitis was present in 33.3% & 66.7% patients (p=0.0001), dorsal myelitis in 70.0% & 30.0% (p=0.089), optic neuritis in 57.1% & 42.9% (p=0.05), bilateral lower limb weakness in 33.3% & 66.7% (p=0.144) and urinary retention in 50.0% each (p=0.670) whereas the radiological features of patients were; fundoscopy was found normal in 25.9% & 74.1% (p=0.002), CSF findings were as; normal in 7.1% & 92.9% (p=0.0001), raised protein in 14.3% & 85.7% (p=0.032), raised protein, mononuclear pleocytosis in 42.9% & 57.1% (p=0.450), MRI brain was normal in 17.8% & 82.2% (p=0.0001), MRI orbit was normal in 28.6% & 71.4% (p=0.0001) and MRI spine was normal in 33.3% & 66.7% (p=0.205).
CONCLUSION
AQP4+ NMOSD had predominantly cervical myelitis and optic neuritis. On radiographs, Anti-AQP4+ cases had longitudinally extensive transverse myelitis in the cervical region while Anti-MOG+ patients had greater conus involvement and dorsal myelitis. MOGAD patients presented at a younger age as compared to AQP4+. Patients with Anti-AQP4+ showed higher residual disability compared to MOGAD patients. For accurate diagnosis, treatment, and prognosis, these distinctions are crucial. Clinical outcome and quality of life should be improved through research of these continued disorders.
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Dr. Huma Khan
MBBS, Postgraduate Trainee, Jinnah Postgraduate Medical Center,
Dr. Khalid Sher
HOD & Professor, MBBS, FCPS, Jinnah Postgraduate Medical Center,
Dr. Salman Naseer Baloch
Postgraduate Trainee, MBBS, Jinnah Postgraduate Medical Center,
Dr. Muhammad Nawaz Chachar
Postgraduate Trainee, MBBS, Jinnah Postgraduate Medical Center,
Dr. Jetender Maheshwari
Consultant Physician, MBBS, FCPS, Kutiyana Memon Hospital,
Sajid Atif Aleem
Lecturer, MSc, MPhil, Jinnah Sindh Medical University, CONTACT NUMBER:0300-2527673