The atypical faces of optic neuritis: neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease

Sabrina Poonja; Natthapon Rattanathamsakul; John J Chen

doi:10.1097/WCO.0000000000001335

The atypical faces of optic neuritis: neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease

Curr Opin Neurol. 2024 Nov 21. doi: 10.1097/WCO.0000000000001335. Online ahead of print.

Authors

Sabrina Poonja¹, Natthapon Rattanathamsakul^{1

2}, John J Chen^{1

3

4}

Affiliations

¹ Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
² Division of Neurology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
³ Department of Neurology.
⁴ Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA.

PMID: 39564614
DOI: 10.1097/WCO.0000000000001335

Abstract

Purpose of review: The purpose of this article is to provide a review of neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), with a focus on what renders optic neuritis "atypical" in these two conditions. Clinical features, diagnostic criteria, and epidemiology are outlined. Acute treatments for optic neuritis, as well as immunotherapy for NMOSD and MOGAD are discussed.

Recent findings: Updates in NMOSD and MOGAD are highlighted, with an emphasis on novel work including the new 2023 MOGAD diagnostic criteria, our evolving understanding on the epidemiology of these conditions, and recently FDA-approved NMOSD treatments. Pipeline therapies are also discussed.

Summary: A thorough history and examination, supported by ancillary testing, continues to be the mainstay of optic neuritis diagnosis. Stratifying typical versus atypical optic neuritis is paramount. Within the atypical category, NMOSD and MOGAD are important considerations. Clues can point towards these diagnoses and guide steps for treatment, which is increasingly becoming targeted to individual diseases, as the pathophysiology is different for these disorders.