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Multiple sclerosis — ABIM Board MCQ

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HardNeurologyMultiple sclerosisABIM Board

A 32-year-old woman has a second episode of severe bilateral optic neuritis. MRI shows longitudinal enhancement of more than half of each optic nerve with perineural enhancement; brain MRI lacks typical periventricular MS lesions. Which test is most appropriate?

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Correct answer: C — Obtain serum MOG-IgG using a validated cell-based assay

The best answer is “Obtain serum MOG-IgG using a validated cell-based assay”. Bilateral, severe, longitudinally extensive optic neuritis with perineural enhancement and an MRI not typical for MS is a core phenotype that should prompt MOG-IgG testing. A cell-based serum assay is preferred. Oligoclonal bands can support MS but are neither required nor disease-specific for MOGAD.

Reference: International MOGAD Panel Proposed Diagnostic Criteria: https://pubmed.ncbi.nlm.nih.gov/36725904/