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Multicenter Study
. 2025 Jan 1;30(1):17-22.
doi: 10.1097/NRL.0000000000000577.

Increased Intracranial Pressure in Myelin-Oligodendrocyte Glycoprotein Antibody-Associated Disease

Torge Rempe  1 , Aisha Elfasi  1 , Samir Alkabie  2 , Alison Christy  3 , Elsa Rodriguez  1 , Rhaisa Castrodad-Molina  4 , Bryce Buchowicz  1 , Fernando X Cuascut  4 , George Hutton  4 , Revere Kinkel  5 , Jennifer Graves  5
Affiliations
Multicenter Study

Increased Intracranial Pressure in Myelin-Oligodendrocyte Glycoprotein Antibody-Associated Disease

Torge Rempe et al. Neurologist. .

Abstract

Objectives: To assess characteristics of increased intracranial pressure (ICP) in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).

Methods: This is a multicenter retrospective review of 84 MOGAD cases at the University of Florida, Baylor College of Medicine, the University of California San Diego, and Providence Health and Services, Portland, Oregon, to identify cases with a documented increased opening pressure >25 cm H2O. A literature review was conducted to identify previously reported MOGAD cases with an opening pressure >25 cm H2O.

Results: Of 28 MOGAD cases with available opening pressures, 6 (21.4%) patients (age: 5 to 36 y; 2/6 females) had documented increased ICP with an opening pressure of 26 to 46 cm H2O and optic nerve head edema on funduscopic examination. The increased ICP occurred in the setting of bilateral optic neuritis in all cases. In 5/6 patients, this was the initial presentation of the disorder. Anti-MOG titers were 1:40 (n = 1), 1:100 (n = 4), and 1:1000 (n = 1). In our literature review, we identified 13 additional MOGAD cases with ICP elevations in the setting of meningo-cortical presentations (n = 10), as well as bilateral optic neuritis (n = 3).

Conclusions: Increased ICP may occur in MOGAD and may be more common in patients with optic neuritis or meningoencephalitis.

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Conflict of interest statement

T.R. received grant funding from the National Multiple Sclerosis Society. He served on scientific advisory boards for Genentech, Sanofi-Genzyme, Alexion, and Amgen. He receives contract research support from Genentech, Sanofi-Genzyme, Celgene, and Novartis. A.C. receives research support from Biohaven and Novartis. F.X.C. reports participation in scientific advisory boards for Horizon, Biogen, and Novartis, as well as receiving speaker fees from Biogen. G.H. reports participation in scientific advisory boards for Novartis, Genentech, Genzyme, Bristol Myers Squibb, and Autoimmunity Biologic Solution, Inc. and has also received research funding/commercial entities from Genzyme, Biogen, Novartis, Hoffmann La Roche, and MedImmune. R.K. has received honoraria for non-promotional educational activity from Biogen and received speaker fees from Alexion, Biogen, BMS, Genentech, and Sanofi-Genzyme. J.G. has received research support from NMSS, Octave, Biogen, EMD Serono, Novartis, ATARA Biotherapeutics, and ABM. She has served on an advisory board for TG therapeutics and a pediatric clinical trial steering committee for Novartis. She has consulted for Google. The remaining authors declare no conflict of interest.

References

    1. Rees JH, Rempe T, Tuna IS, et al. Neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein antibody-associated disease. Magn Reson Imaging Clin N Am. 2024;32:233–251.
    1. Banwell B, Bennett JL, Marignier R, et al. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. Lancet Neurol. 2023;22:268–282.
    1. Rempe T, Tarhan B, Rodriguez E, et al. Anti-MOG associated disorder-Clinical and radiological characteristics compared to AQP4-IgG+ NMOSD-A single-center experience. Mult Scler Relat Disord. 2021;48:102718.
    1. Alqahtani Y, Oshi M, Kamal NM, et al. Pediatric myelin oligodendrocyte glycoprotein antibody associated disease—asymmetric papilledema and elevated ICP are two of the chameleons: a case report. Medicine (Baltimore). 2023;102:e32986.
    1. Chaudhuri JR, Bagul JJ, Swathi A, et al. Myelin oligodendrocyte glycoprotein antibody-associated disease presenting as intracranial hypertension: a case report. Neurol Neuroimmunol Neuroinflamm. 2022;9:e200020.

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