Anti-MOG Antibody Associated Disorders in Pakistan

Objective: To present clinicopathological features and treatment outcomes of patients who tested positive for anti-myelin oligodendrocyte glycoprotein (MOG) antibodies in the catchment Pakistani population. Study Design: Observational study. Place and Duration of the Study: Department of Immunology and Neurology, Shifa International Hospital / Shifa Tameer-e-Millat University, Islamabad, Pakistan, from January 2018 to December 2022. Methodology: A review of patients referred for anti-MOG antibody testing was conducted. Indirect immunofluorescence was used to analyse all samples on EU 90 cells transfected with MOG genes. Patients who tested positive for anti-MOG antibodies were included in the study. Patients’ medical records and interviews were used to gather clinical data, as per the objective. Results: One hundred and fourteen patients out of 740 were tested positive for anti-MOG antibodies. A total of 59 patients were included for final analysis, and 78 (68.4%) of the seropositive population were male, with a mean age of 24 years ± 15.8 years (range 4-59 years). The most frequent clinical presentation was visual impairment in 39/59 (66%) patients, followed by muscle weakness in 36/59 (61%) and headache in 30/59 (50%) patients. Treatment included intravenous methylprednisolone, oral prednisolone, plasma exchange, rituximab, intravenous immunoglobulins, azathioprine, mycophenolate mofetil, cyclophosphamide, and methotrexate. Conclusion: The present study showed a higher percentage of males tested positive for anti-MOG antibodies. MOG-associated disorders can affect both children and adults. The most frequent clinical presentations of MOGAD in this study were visual impairment, followed by muscle weakness. The primary clinical phenotype identified was isolated transverse myelitis.