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MOG antibody-associated disease — SCE Neurology MCQ

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HardMultiple sclerosisMOG antibody-associated diseaseSCE Neurology

A 9-year-old develops bilateral optic-disc swelling, painful visual loss and an ADEM-like encephalopathy after a febrile illness. MRI shows fluffy cortical-subcortical lesions and longitudinal optic-nerve enhancement; AQP4-IgG is negative. Which test best addresses the leading diagnosis?

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Correct answer: A — Serum MOG-IgG using a validated live cell-based assay

The best answer is “Serum MOG-IgG using a validated live cell-based assay”. Bilateral optic neuritis with ADEM-like brain lesions in a child is a core MOGAD phenotype; diagnosis requires compatible clinical features and reliable serum MOG-IgG methodology. “CSF JC-virus PCR using an ultrasensitive laboratory assay” is less appropriate because JC-virus testing addresses PML in an immunocompromised host rather than this acute phenotype “Serum acetylcholine-receptor and MuSK antibody testing” is less appropriate because AChR antibodies assess neuromuscular transmission and do not diagnose optic-nerve inflammation “NOTCH3 sequencing for a hereditary cerebral arteriopathy” is less appropriate because CADASIL does not explain this childhood post-infectious demyelinating syndrome “Skeletal-muscle biopsy with inflammatory and metabolic staining” is less appropriate because muscle tissue cannot establish an antibody-mediated CNS demyelinating disorder

Reference: International MOGAD diagnostic criteria. https://pubmed.ncbi.nlm.nih.gov/36706773/