Basic CSF parameters and MRZ reaction help in differentiating MOG antibody-associated autoimmune disease versus...

Area of Science:

• Neurology
• Immunology
• Clinical Diagnostics

Background:

• Myelin oligodendrocyte glycoprotein antibody-associated autoimmune disease (MOGAD) is a rare central nervous system (CNS) inflammatory demyelinating disorder.
• MOGAD can clinically mimic multiple sclerosis (MS), complicating diagnosis.
• Limited data exists on cerebrospinal fluid (CSF) profiles differentiating MOGAD from MS.

Purpose of the Study:

• To analyze basic CSF parameters for distinguishing MOGAD clinical phenotypes.
• To differentiate MOGAD from MS using CSF analysis.

Main Methods:

• Retrospective analysis of 30 adult MOGAD and 189 adult relapsing-remitting MS patients.
• Evaluation of CSF white cell count (WCC), CSF/serum albumin ratio (Q_Alb), immunoglobulin production, CSF-restricted oligoclonal bands (OCB), and MRZ reaction.

Main Results:

• MOGAD patients with myelitis showed higher WCC and Q_Alb compared to those with optic neuritis.
• MOGAD patients had more neutrophils, higher WCC and Q_Alb, but fewer plasma cells and OCB compared to MS patients.
• Absence of CSF-restricted OCB (PLR 14.32) and elevated Q_Alb>10×10^-3 (PLR 12.60) were key indicators for MOGAD; a positive MRZ reaction was absent in MOGAD.

Conclusions:

• Basic CSF parameters show variability in MOGAD phenotypes.
• Elevated Q_Alb and absence of CSF-restricted OCB are valuable for differentiating MOGAD from MS.
• A positive MRZ reaction is a strong indicator against MOGAD, aiding diagnosis.