Abstract | BACKGROUND: METHODS: This was a multicenter cross-sectional study of MOGAD and MS patients with peripapillary retinal nerve fiber layer (pRNFL) thickness measured with OCT within two weeks of acute ON symptom. Cirrus HD-OCT (Carl Zeiss Meditec, Inc. Dublin, CA, USA) was used to measure the pRNFL during acute ON. Eyes with prior ON or disk pallor were excluded. A receiver operating characteristic (ROC) curve analysis was performed to assess the ability of pRNFL thickness to distinguish MOGAD from MS. RESULTS: Sixty-four MOGAD and 50 MS patients met study inclusion criteria. Median age was 46.5 years (interquartile range [IQR]: 34.3-57.0) for the MOGAD group and 30.4 years (IQR: 25.7-38.4) for the MS group (p<0.001). Thirty-nine (61%) of MOGAD patients were female compared to 42 (84%) for MS (p = 0.007). The median pRNFL thickness was 164 µm (IQR: 116-212) in 96 acute MOGAD ON eyes compared to 103 µm (IQR: 93-113) in 51 acute MS ON eyes (p<0.001). The ROC area under the curve for pRNFL thickness was 0.81 (95% confidence interval 0.74-0.88) to discriminate MOGAD from MS. The pRNFL cutoff that maximized Youden's index was 118 µm, which provided a sensitivity of 74% and specificity of 82% for MOGAD. Among 31 MOGAD and 48 MS eyes with an unaffected contralateral eye or a prior baseline, the symptomatic eye had a median estimated pRNFL thickening of 45 µm (IQR: 17-105) and 7.5 µm (IQR: 1-18), respectively (p<0.001). All MOGAD affected eyes had a ≥ 5 µm pRNFL thickening, whereas 26 (54%) MS affected eyes had a ≥ 5 µm thickening. CONCLUSION: OCT-derived pRNFL thickness in acute ON can help differentiate MOGAD from MS. This can aid with early diagnosis and guide disease-specific therapy in the acute setting before antibody testing returns, and help differentiate borderline cases. In addition, pRNFL thickening is a sensitive biomarker for confirming acute ON in MOGAD, which is clinically helpful and could be used for adjudication of attacks in future MOGAD clinical trials.
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Authors | John J Chen, Elias S Sotirchos, Amanda D Henderson, Eleni S Vasileiou, Eoin P Flanagan, M Tariq Bhatti, Sepideh Jamali, Eric R Eggenberger, Marie Dinome, Larry P Frohman, Anthony C Arnold, Laura Bonelli, Nicolas Seleme, Alvaro J Mejia-Vergara, Heather E Moss, Tanyatuth Padungkiatsagul, Hadas Stiebel-Kalish, Itay Lotan, Mark A Hellmann, Dave Hodge, Frederike Cosima Oertel, Friedemann Paul, Shiv Saidha, Peter A Calabresi, Sean J Pittock |
Journal | Multiple sclerosis and related disorders
(Mult Scler Relat Disord)
Vol. 58
Pg. 103525
(Feb 2022)
ISSN: 2211-0356 [Electronic] Netherlands |
PMID | 35038647
(Publication Type: Journal Article, Multicenter Study)
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Copyright | Copyright © 2022. Published by Elsevier B.V. |
Topics |
- Adult
- Cross-Sectional Studies
- Female
- Humans
- Middle Aged
- Multiple Sclerosis
(complications, diagnostic imaging)
- Nerve Fibers
- Optic Neuritis
(diagnosis)
- Tomography, Optical Coherence
(methods)
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