By Joene Hendry
Source: New England Journal of Medicine (NEJM)
Among individuals who experience an initial demyelinating event suggestive of multiple sclerosis, those who are seropositive for antibodies against myelin oligodendrocyte glycoprotein (MOG) and myelin basic protein (MBP) or are seropositive only for MOG antibodies experience relapse more often and earlier than individuals seronegative to the antibodies.
Thomas Berger, MD, of the University of Innsbruck, Austria and colleagues conducted serum testing for anti-MOG and anti-MBP antibodies in 103 patients with a clinically isolated syndrome suggestive of multiple sclerosis. The patients all showed white-matter lesions on cerebral magnetic resonance imaging (MRI) and oligoclonal bands in their cerebrospinal fluid.
All patients were initially treated with 1000 mg intravenous methylprednisolone for 3 to 5 consecutive days and underwent neurological examination at base line and every 3 months during the study period. The patients' age at disease onset ranged from 13 to 54 years, 73 patients were female, and the mean follow-up period was 50.9 months.
Among the antibody seronegative patients, 77% remained relapse-free during follow-up. The seronegative patients who experienced relapse (23%) had a mean time to relapse of 45.1 months.
Conversely, among the patients seropositive only for anti- MOG antibodies 83% had a relapse within a mean of 14.6 months when compared with the seronegative group. Among patients seropositive for both anti-MOG and anti-MBP, 95% experienced relapse within a mean of 7.5 months compared with the seronegative group.
Additional analysis revealed that patients seropositive to both anti-MOG and anti-MBP antibodies had higher mean numbers of lesions on T2-weighted and T1-weighted, gadolinium-enhanced MRI than those patients seronegative for the antibodies.
Dr. Berger and colleagues conclude, "in individual patients with a clinically isolated syndrome, the initial detection of serum antibodies against MOG and MBP predicts early conversion to clinically definite multiple sclerosis, whereas the absence of these antibodies suggests that the patient will remain disease-free for several years." "The predictive value of antimyelin antibodies," they add, "may be important for counseling purposes or for early treatment to prevent the disease from progressing."
N Engl J Med 2003;349:2:139-45.
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