B-185 Comparison of clinical and paraclinical features among NMOSD, MOGAD, and seronegative patients

Abstract

Background Neuromyelitis optica spectrum disorders are autoimmune inflammatory diseases of the central nervous system, most commonly associated with anti-aquaporin-4 antibodies. A subset of patients with similar clinical presentations but negative for anti-aquaporin-4 antibodies has been identified with anti-myelin oligodendrocyte glycoprotein antibodies and classified as myelin oligodendrocyte glycoprotein antibody-associated disease. Additionally, some patients remain negative for both antibodies, creating diagnostic and therapeutic challenges. Methods A retrospective descriptive study was conducted on 75 patients with NMOSD-like clinical presentations diagnosed and treated at the University Medical Center Ho Chi Minh City from January 2022 to July 2024. Patients were stratified into three groups based on serostatus: anti-aquaporin-4 positive NMOSD, anti-myelin oligodendrocyte glycoprotein positive disease, and double-seronegative. Demographic characteristics, clinical manifestations, and paraclinical findings, including cerebrospinal fluid and serum immunological indices, were compared among the groups. Results The cohort had a mean age of 43.6 years with a strong female predominance, showing a female-to-male ratio of 6.5 to 1. Anti-aquaporin-4 antibodies were detected in 72 percent of patients, while 12 percent were classified as myelin oligodendrocyte glycoprotein antibody-associated disease and 16 percent were double-seronegative. The anti-aquaporin-4 positive group demonstrated the highest female predominance and significantly higher serum IgG levels (p < 0.001). Patients with myelin oligodendrocyte glycoprotein antibody-associated disease showed higher cerebrospinal fluid IgG levels (p = 0.019). Seronegative patients exhibited overlapping clinical and paraclinical features. Conclusion Antibody-based stratification revealed distinct clinical and paraclinical profiles among NMOSD, myelin oligodendrocyte glycoprotein antibody-associated disease, and seronegative patients. Anti-aquaporin-4 positivity accounted for the majority of cases in this cohort. In patients negative for anti-aquaporin-4 antibodies, additional anti-myelin oligodendrocyte glycoprotein testing and close clinical follow-up are essential to support accurate diagnosis and appropriate management.