Prodromal headache in MOG-antibody positive optic neuritis
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Published on: April 15, 2014
Susanna Asseyer1, Josh Hamblin2, Silvia Messina2
1Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine & Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Germany; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin, and Berlin Institute of Health, Germany; Nuffield Department of Clinical Neurosciences, Level 6, West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
Background:
Myelin oligodendrocyte glycoprotein antibody (MOG-Ab) disease is an inflammatory autoimmune condition of the central nervous system, defined by antibodies (Abs) against MOG. Of the various clinical phenotypes optic neuritis (ON) is the commonest. We have observed that some patients with MOG-Ab ON present with a severe associated headache.
Objective:
To highlight the importance of headache in MOG-Ab related optic neuritis.
Methods:
Clinical and MRI data from MOG-Ab patients with ON (n = 129) were obtained from observational cohort studies and clinical notes at the NeuroCure Clinical Research Center, Charité Berlin and at the Diagnostic and Advisory Service for Neuromyelitis Optica, John Radcliffe Hospital, Oxford.
Results:
Sixty-four of 129 MOG-Ab patients (49.6%) reported ≥1 headache-related ON. Headache usually started a few days prior to visual loss and extended from the ocular region to the periorbital and fronto-temporal area, sometimes mimicking migraine. Of those, thirty-two patients (50%) reported severe headache. Two patients did not have headache. No headache history was recorded for 63 patients. MRIs performed acutely during headache-related MOG-Ab ON (n = 15) showed anterior ON with extensive swelling and edema of the optic nerve/s in all patients, either unilaterally (n = 5) or bilaterally (n = 10). Peri-optic cerebro-spinal fluid (CSF) was undetectable due to the inflammatory extension in 12 out of 15 patients.
Conclusion:
Our findings indicate that acute MOG-Ab ON shows florid intra-orbital and peri‑optic inflammation, likely to involve meninges and nociceptive fibers around the optic nerve. This may explain the frequent and often severe headache that precedes the visual deficit, sometimes misdiagnosed as migraine.
Insights
Headache is a common symptom in myelin oligodendrocyte glycoprotein antibody (MOG-Ab) associated optic neuritis (ON), often preceding vision loss and potentially mimicking migraine. This highlights the importance of recognizing headache in MOG-Ab ON diagnosis.
Area of Science:
- Neuroimmunology
- Ophthalmology
- Neurology
Background:
- Myelin oligodendrocyte glycoprotein antibody (MOG-Ab) disease is an autoimmune CNS disorder characterized by antibodies against MOG.
- Optic neuritis (ON) is the most frequent clinical presentation of MOG-Ab disease.
- Severe headache is an observed, yet under-recognized, symptom in some MOG-Ab ON patients.
Purpose of the Study:
- To emphasize the clinical significance of headache in MOG-Ab related optic neuritis.
- To investigate the characteristics and potential causes of headache in MOG-Ab ON.
Main Methods:
- Retrospective analysis of clinical and MRI data from 129 MOG-Ab patients with ON.
- Data collected from observational cohort studies and clinical notes at specialized centers in Berlin and Oxford.
- Assessment of headache presence, severity, timing, and characteristics in relation to ON onset.
Main Results:
- Nearly half (49.6%) of MOG-Ab ON patients reported headache, often preceding visual loss by days.
- Headache characteristics varied, sometimes mimicking migraine, with 50% of affected patients reporting severe pain.
- MRI in affected patients revealed severe anterior ON with optic nerve swelling, edema, and obliteration of peri-optic CSF space due to inflammation.
Conclusions:
- Acute MOG-Ab ON involves significant intra-orbital and peri-optic inflammation, potentially affecting meningeal and peri-optic nociceptive fibers.
- This inflammation likely explains the frequent and severe headaches observed, which can be misdiagnosed as migraine.
- Recognizing headache as a key symptom can aid in the timely diagnosis and management of MOG-Ab ON.
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