A Longitudinal Comparison of the Recovery Patterns of Optic Neuritis with MOG Antibody-Seropositive and AQP4 Antibody-Seropositive or -Seronegative for Both Antibodies

Abstract

In this study, the aim is to compare the recovery pattern among patients with acute myelin oligodendrocyte glycoprotein antibody-seropositive optic neuritis (MOG-Ab + ON) attacks and aquaporin-4 antibody-seropositive ON (AQP4-Ab + ON) or -seronegative ON. At the onset of the first-ever ON attack, the thickness of RNFL (RNFLt) in the MOG-Ab + ON group was significantly thicker than others (P < 0.05), while visual function damage was not significantly different to other groups. One month to six months after onset, the MOG-Ab + ON group showed significantly better visual function (P < 0.05) than the other two groups, while the RNFLt showed no significant difference among the three groups (P > 0.05). MOG-Ab + ON and AQP4-Ab + ON groups showed rapid recovery in the first month and then plateaued. The annual relapse rate was significantly higher in MOG-Ab + ON and AQP4-Ab + ON groups than seronegative ON. The relapse interval of the MOG-Ab + ON group (9.00 ± 7.86 months) was significantly shorter than that of the AQP4-Ab + ON group (45.76 ± 37.82 months) (P < 0.05) but showed no significant difference from that of the seronegative ON group (P > 0.05). To sum up, the recovery patterns were different among these three types of ON. RNFLt was not parallel to the recovery of visual function among these types of ON. MOG-Ab + ON had the mildest visual function damage but the most substantial RNFL changes, while AQP4-Ab + ON suffered the worst function damage. MOG-Ab + ON had a similar relapse rate as AQP4-Ab + ON but a shorter interval, indicating that relapse prevention was necessary and should be initiated as early as possible.

Figure 1

The basic clinical data of the patients at the first-ever ON attack. (a) The comparison of gender among the patients with MOG-Ab + ON, AQP4-Ab + ON and AQP4-MOG-ON. (b) The comparison of age at first-ever ON attack. (c) The comparison of no. of ON attacks. (d) The comparison of relapse interval between the first attack and the second attack.

Figure 2

The longitude comparison of clinical data among patients with MOG- + AQP4-ON, AQP4-Ab + ON and AQP4-MOG-ON at first-ever ON attack. (a) The comparison of the best corrected visual acuity. (b) The comparison of the mean deviation of visual field. (c) The comparison of amplitude of visual evoked potential (VEP). (d) The comparison of average of the thickness of retinal nerve fiber layer. The visual function including BCVA, MD, and the amplitude of VEP of the MOG-Ab + ON is the best among the three groups throughout the course of the disease at the first onset. Patients with MOG-Ab + ON and AQP4-Ab + ON showed a rapid recovery at 1 M and then plateaued at 1 M to 6 M after the onset of the first-ever attack. However, the recovery of patients with seronegative ON was gradually increased. (d) Significant swelling of the retinal nerve fiber layer could be detected in patients with MOG-Ab + ON. However, there was no difference in the thickness of the retinal nerve fiber layer among the three groups after 6 M. The thickness of the retinal nerve fiber layer of three groups all gradually thinning and shrinking during the course at the first onset.

Figure 3

The comparison of the clinical data for patients with MOG-Ab + ON among the first attack, the second attack, and multiple attacks. (a) The comparison of the best corrected visual acuity. (b) The comparison of the mean deviation of visual field. (c) The comparison of amplitude of visual evoked potential (VEP). (d) The comparison of average of the thickness of retinal nerve fiber layer. (a–c) The visual function was not significantly decreased after twice or more attacks compared with the first attack. (d) The RNFL became thinner with each ON attack, though no significant difference could be found. The tendency of the change of RNFL of the optic nerve could be more and more stead and gentle with each attack.

Figure 4

The comparison of the clinical data for patients with AQP4-Ab + ON among the first attack, the second attack, and multiple attacks. (a) The comparison of the best corrected visual acuity. (b) The comparison of the mean deviation of visual field. (c) The comparison of amplitude of visual evoked potential (VEP). (d) The comparison of average of the thickness of retinal nerve fiber layer. (a–c) Significant difference could not detect among the first attack, the second attack, and multiple attacks. (d) While gradually thinning of the RNFL could be detected with each ON attack, though no significant difference could be found.

Figure 5

Comparison of the recovery trend after multiple attacks between patients with MOG-Ab + ON and patients with AQP4-Ab + ON. (a) The comparison of the best corrected visual acuity. (b) The comparison of the mean deviation of visual field. (c) The comparison of amplitude of visual evoked potential (VEP). (d) The comparison of average of the thickness of retinal nerve fiber layer. The visual function (BCVA, MD, and VEP) of patients with MOG-Ab + ON is better than that of patients with AQP4-Ab + ON from the onset to 6 M during the course of the last attack, although no significance could be detected. The impairment of the thickness of the RNFL of the optic nerve is similar to each other.