Understanding the Differences in Brain Lesions between Relapsing-Remitting MS, AQP4-NMOSD, and MOG Disorder

Multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are three distinct conditions that affect the central nervous system. While they share some similarities, each condition has its unique characteristics, including patterns of brain and spinal cord lesions.

A recent study compared the patterns of brain and spinal cord lesions between relapsing-remitting MS (RRMS), AQP4 antibody-positive NMOSD (AQP4-NMOSD), and MOGAD. The findings revealed significant differences in the distribution and characteristics of these lesions.

In RRMS, white matter lesions tend to affect specific brain regions, such as the periventricular and juxtacortical white matter, the corpus callosum, and the infratentorial areas. In contrast, AQP4-NMOSD is characterized by brain abnormalities frequently located in areas with high aquaporin-4 (AQP4) expression, such as periependymal lesions surrounding the ventricles or involving corticospinal tracts.

MOGAD, on the other hand, is associated with large, ill-defined or defined lesions mostly located in the deep gray matter and the cerebellar peduncles. These findings suggest that each condition has a unique pattern of brain and spinal cord involvement.

The study also found that higher cortical lesion number combined with higher retinal nerve fiber layer (RNFL) thickness best differentiated RRMS from MOGAD. Additionally, white matter lesions, cortical lesions, and RNFL thickness were the most accurate measures favoring RRMS over MOGAD.

In distinguishing RRMS from AQP4-NMOSD, the combination of a higher proportion of central vein sign (CVS), cortical lesions, and optic nerve magnetization transfer ratio reached the highest accuracy. The proportion of lesions with the CVS was also found to be significantly higher in RRMS compared to AQP4-NMOSD.

Overall, this study highlights the importance of understanding the differences in patterns of brain and spinal cord lesions between these three conditions. This knowledge can help clinicians develop more accurate diagnostic criteria and improve patient outcomes.

The study included 91 consecutive patients (31 RRMS, 30 AQP4-NMOSD, and 30 MOGAD) and 34 healthy controls. The findings have significant implications for our understanding of these complex conditions and may lead to the development of new treatments targeted at specific brain regions or pathophysiological mechanisms.

Mog disorder