![]() ADEM tends to strike children much more than adults whereas MOG is found in both children and adults alike. MS patients are slightly older than MOG patients on average and share the propensity for Caucasian descent but women with MS outnumber men by 3:1. This is different from AQP4 NMOSD in which the average age of onset is in the late 30s/early 40s, race is overrepresented by non-Caucasians and females dominate up to 9:1. Recent data suggest that MOG antibody disease is generally a condition of younger Caucasians with less female predominance compared to other autoimmune diseases of the central nervous system (CNS). These studies contribute to the emerging consensus that MOG antibody disease is likely to be a separate immunopathological entity with a distinctive clinical signature. Most of these cases were previously diagnosed as ADEM or recurrent ADEM but with widespread availability of MOG antibody testing since 2015, several case series and reports have been published on cases of encephalitis associated with MOG antibody. In this review, we focus on encephalitis associated with the MOG antibody. MOG has been ironically unique in that it shares features of NMOSD, MS and ADEM with only a serological antibody to distinguish itself. Unlike ADEM which is classically monophasic, seropositivity of the MOG antibody portends a high likelihood of relapse. When MOG antibody disease involves the brain, the phenotype is similar to acute disseminated encephalomyelitis (ADEM) with alterations in mental status and good outcomes after treatment with corticosteroids and intravenous immunoglobulins. Thus, immune mediated attacks against MOG appear to be more demyelinating compared with AQP4 NMOSD, and therefore MOG is closer to multiple sclerosis (MS) in terms of its immunopathological features. ![]() However, unlike AQP4 which is an astrocytic protein, MOG is expressed on the outer surface of CNS myelin. It accounts for up to 40% of NMOSD patients who are seronegative for the aquaporin-4 (AQP4) antibody. Clinically, MOG antibody disease bears resemblance to neuromyelitis optica spectrum disorder (NMOSD) in the localization of inflammatory attacks within the central nervous system. MOG antibody disease refers to a relatively new spectrum of autoimmune disorder with antibodies against the myelin oligodendrocyte glycoprotein (MOG) predominantly involving the optic nerve and spinal cord leading to vision loss and paralysis. ![]()
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