Myelin Oligodendrocyte Glycoprotein-Related Isolated Internuclear Ophthalmoplegia Mimicking Multiple Sclerosis

• Published in: Canadian journal of neurological sciences 2024-09, Vol.51 (5), p.717-718
• Main Authors: Handzic, Armin, Margolin, Edward
• Format: Article
• Language: English
• Subjects: Antibodies; Diplopia; Glycoproteins; Letter to the Editor: New Observation; Motility; Multiple sclerosis; Spinal cord
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/cjn.2023.301

A recent systematic review on ophthalmic manifestations of MOG-AD other than optic neuritis listed only one report of INO from Vecchio et al.1 However, in that case, INO was associated with longitudinally extensive transverse myelitis with rapid worsening to tetraparesis and need for mechanical ventilation.3 While brainstem involvement in MOG-AD seems to be a risk factor for negative clinical outcomes, our case raises awareness that isolated INO with fast spontaneous recovery can occur. [...]treatment approach to patients with isolated clinical syndromes secondary to MOG-AD is challenging. Ambrosius et al. reported that disability progression in MOG-AD is relapse-dependent, which furthers the clinical dilemma about initiation of treatment.4 Thus the decision about starting long-term immunosuppression must be considered on an individual basis and reserved for patients with poor recovery after the first episode of MOG-AD or for those who experienced a second attack. [...]there might be little adaptive myelination in “one way” information pathways, whose task is simply to conduct impulses as fast as possible, such as in the spinal cord or optic nerve. [...]the less altered intrinsic myelin might be more prone to be affected by anti-MOG antibodies and might explain why the brainstem is less often involved in MOG-AD as it does not represent a “one way” pathway.