Abstract Details

Title Frequency of Optic Nerve Enhancement During Acute Optic Neuritis in MOG Antibody-associated Disease

Topic Autoimmune Neurology

Presentation(s) S6 - Autoimmune Neurology: NMOSD and MOGAD (1:36 PM-1:48 PM)

Poster/Presentation
Number 004

Objective To determine the frequency of post-contrast enhancement on orbital MRI during acute optic neuritis(ON) in myelin oligodendrocyte glycoprotein antibody-associated disease(MOGAD).

Background ON is the most common manifestation of MOGAD. MRI is routinely used to evaluate relapses in MOGAD, however, the sensitivity of T1 post-contrast enhancement on orbital MRI in MOGAD associated acute ON has not been established.

Design/Methods In this retrospective study, patients referred to the Mayo Clinic who met the diagnostic criteria for MOGAD, presented with acute ON, completed MRI with fat suppression of the orbit within 30 days of the onset of visual symptoms, and had adequate clinical data for review were included. Available clinical data and the presence of T1 post-contrast enhancement were evaluated.

Results This study included 122 patients with MOGAD (median age: 39 years [range, 6-72], 68% female) with 177 acute ON attacks. Bilateral ON occurred in 34/122(28%) of patients. MRIs were completed a median of 6 days (range, 0-26) after the onset of visual loss. Of included attacks, 119/170(70%) had a visual acuity 20/40 or worse, 77/170(45%) had a visual acuity 20/200 or worse, and 157/173(91%) had pain with eye movements during acute ON. Optic nerve T1 post-contrast enhancement was present in 173/177 ON attacks(97.7%). ON was confirmed in attacks without enhancement on MRI by at least one of the following: retinal nerve fiber layer swelling on optical coherence tomography(n=2), enhancement on a second MRI within the acute presentation(11 days later, n=1), and/or new T2 hyperintensity of the optic nerve on a follow-up MRI scan(n=2).

Conclusions Contrasted MRI with fat suppression is highly sensitive for the detection of acute ON in MOGAD and can aid in diagnosis. In rare cases, enhancement may not be present in MOGAD acute ON and ancillary testing including OCT and follow-up MRI may be helpful for diagnosis.

Authors/Disclosures
Stephanie Syc-Mazurek, MD, PhD (Mayo Clinic) PRESENTER	Dr. Syc-Mazurek has a non-compensated relationship as a Editorial Board Resident and Fellows Section with Neurology that is relevant to AAN interests or activities.
Nanthaya Tisavipat, MD (Mayo Clinic)	Miss Tisavipat has nothing to disclose.
Natthapon Rattanathamsakul, MD (Mayo Clinic)	Dr. Rattanathamsakul has nothing to disclose.
Paul Farnsworth, DO	Dr. Farnsworth has nothing to disclose.
Moritz Niederschweiberer	No disclosure on file
M. Tariq Bhatti, MD (Kaiser Permanente, Northern California)	Dr. Bhatti has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Receptos . Dr. Bhatti has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH LHON gene therapy study .
Kevin Chodnicki (Mayo Clinic)	Kevin Chodnicki has nothing to disclose.
Deena Tajfirouz, MD	Dr. Tajfirouz has nothing to disclose.
Sean J. Pittock, MD, FAAN (Mayo Clinic Dept of Neurology)	Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic)	The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Merck. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology that is relevant to AAN interests or activities.
John Chen	John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. John Chen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. John Chen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB.

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