Table 1

Demographic, clinical, laboratory and radiological differential features between CNS inflammatory diseases (AQP4 antibody NMOSD characteristics from ref 37)

MOG antibody diseaseAQP4 antibody NMOSDMultiple sclerosis
Age of onsetBoth children and adults, broad age of onset.More common in adults, mean age at onset 39 year old.Mostly young adults.
SexNo sex predominance.Predominantly females (9:1).More common in females (3:1).
EthnicityNo ethnic bias.Over-represented in Asian and
Afro-Caribbean races.
Predominantly Caucasian.
Onset presentation
  • 50% unilateral or bilateral ON.

  • 20% ADEM or brainstem attacks.

  • 20% LETM.

  • 10% simultaneous ON and TM.

  • Unilateral ON.

  • LETM.

  • Area postrema syndrome.

  • Unilateral ON.

  • Brainstem/cerebellar symptoms.

  • Myelitis, often mild and sensory.

Disease courseMonophasic or relapsing, no disease progression.Relapsing, no disease progression.Relapsing and secondary progressive or primary progressive.
Brain MRI (typical or characteristic appearances)
  • Can have normal brain MRI (lesions were associated with ADEM or brainstem attacks).

  • Typical ADEM features: poorly demarcated white and grey matter lesions often involving the thalamus and basal ganglia.

  • Poorly demarcated brainstem lesions, often located in the pons or cerebellar peduncles, adjacent to the ventricular system.

  • Less common selective oedematous cortical lesions, typically unilateral.

  • Can have normal brain MRI (lesions were associated with brainstem/diencephalic/cerebral attacks).

  • Brainstem and diencephalic lesions surrounding the ventricular system, including area postrema lesions.

  • Other characteristic features include long ‘pencil thin’ callosal lesions, long corticospinal tract lesions.

  • Well-demarcated ovoid or finger-like lesions perpendicular to the lateral ventricles.

  • Curved juxtacortical lesions.

  • Inferior temporal lobe lesions.

  • Small cortical lesions.

  • Frequent T1 lesions (black holes).

Optic nerve MRI
(no finding is exclusive to one condition, but some appearances are more common for each disease)
  • Extensive (≥0.5 length) lesions involving the anterior segments.

  • Optic chiasm usually spared.

  • Commonly bilateral.

  • Perioptic gadolinium enhancement.

  • Extensive lesions involving the posterior segments and optic chiasm.

  • Might be bilateral

  • Short unilateral optic nerve lesions.

New lesions on follow-up brain MRI outside of relapse.Rare.Rare.Accumulation of silent T2 lesions over time, new gad-enhancing lesions.
Spinal cord MRI
  • Usually long (at least three segments), oedematous and central lesions.

  • Short lesions in up to 25%.

  • Conus lesions common.

Usually long, oedematous and central lesions, short lesions can occur.Short-segment (one or two segments), asymmetrical on axial views.
CSF
  • 50% elevated cells.

  • OCB in a minority.


  • Elevated cells with possible neutrophils/eosinophils.

  • OCB in a minority.

  • Cells typically low, unmatched

  • OCB present in a majority.

  • ADEM, acute demyelinating encephalomyelitis; AQP4, aquaporin-4; CNS, central nervous system; CSF, cerebrospinal fluid; LETM, longitudinally extensive transverse myelitis; NMOSD, neuromyelitis optica spectrum disorders; OCB, oligoclonal bands; ON, optic neuritis; TM, transverse myelitis.