December 13, 2016 E-Pearl of the Week: Aquaporin-4 antibody-negative neuromyelitis optica

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December 13, 2016

Aquaporin-4 antibody-negative neuromyelitis optica

Neuromyelitis optica (NMO) is an aggressive inflammatory neurologic disease associated with optic neuritis and longitudinally extensive cord lesions. Serologic testing for aquaporin-4 IgG (AQP4) antibodies is only 80% sensitive. In AQP4-negative cases, anti-myelin oligodendrocyte glycoprotein (anti-MOG) antibodies are observed 10-20% of the time. Compared to patients with AQP4 antibodies, those with anti-MOG are younger, less commonly female (2:1 M:F vs. 1:9 in AQP4 disease), and almost never relapse. In patients without AQP4 antibodies, anti-MOG testing should be performed as it heralds a more benign prognosis.


  1. Sato DK, Callegaro D, Lana-Peixoto MA, Waters PJ, de Haidar Jorge FM, Takahashi T, et al. Distinction between mog antibody-positive and aqp4 antibody-positive nmo spectrum disorders. Neurology. 2014; 82: 474-481.

James E. Siegler III, MD, Resident Physician - Department of Neurology, Hospital of the University of Pennsylvania. Dr. Siegler is a member of the Resident and Fellow Section of Neurology

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