MOG antibodies in combined central and peripheral demyelination syndromes

Antibodies against myelin oligodendrocyte glycoprotein (MOG) have been identified in CNS inflammatory demyelinating disorders (IDDs) including neuromyelitis optica spectrum disorders (NMOSDs) without aquaporin-4 (AQP-4) antibodies. As in NMOSD, spinal cord and optic nerves are 2 of the most frequently involved CNS sites in combined central and peripheral demyelination (CCPD) syndromes.1–3 Spinal cord lesions of variable length and abnormal visual evoked potentials with and without clinical optic neuritis have been commonly described in CCPD series and single reports, but AQP-4 antibodies were detected in a minority of patients.1–4 MOG antibodies have not been reported in CCPD cases, and their role in CCPD is largely unknown. The clinical relevance of previously suggested antigens, such as neurofascin-155 (NF-155), expressed both in peripheral and central myelin, remains controversial. We present a CCPD case with elevated serum MOG-IgG1 antibodies and suggest their potential role in CCPD syndromes. The authors thank Dr. Jennifer M. Martinez-Thompson and Dr. P. James B. Dyck (Department of Neurology, Mayo Clinic Rochester, MN) for providing the sural nerve biopsy images and for interpretation of the histological preparations.