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AQP4-IgG cell-based antibody testing is essential for diagnosing NMOSD1,2

Early, accurate diagnosis is crucial to beginning treatment that may prevent potentially irreversible damage1-3

AQP4-IgG
detection method4		 Sensitivity % Specificity %
Cell-based assay
(recommended)		 92 100
ELISA 60 97
five-times-more-likely-icon

Likelihood of a false-negative result with an ELISA assay is almost 5 times greater4

  • More likely to occur during the recovery period following an attack, when taking an immunosuppressant, or due to the test’s relative inaccuracy5
  • Consider retesting an AQP4-IgG negative patient within 3 to 6 months5
serum-cell-based-assay-test-icon

Serum cell-based assays are the most sensitive method to detect AQP4-IgG antibodies (present in up to 90% of NMOSD cases)1,3,6,7

  • Testing cerebrospinal fluid is less informative and offers no added value8
further-testing-mog-autoantibodies-icon

Further testing for MOG autoantibodies in AQP4-IgG negative patients can help identify MOGAD9

Explore the evolution of NMOSD treatment Treatment Evolution

ELISA, enzyme-linked immunosorbent assay; MOGAD, myelin oligodendrocyte glycoprotein antibody disease.

  • References

    1. Wingerchuk DM, Banwell B, Bennett JL, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology. 2015;85:177-189.
    2. Borisow N, Mori M, Kuwabara S, et al. Diagnosis and treatment of NMO spectrum disorder and MOG-encephalomyelitis. Front Neurol. 2019;9:1-9. doi:10.3389/fneur.2018.00888
    3. Hamid SHM, Whittam D, Mutch K, et al. What proportion of AQP4‐IgG‐negative NMO spectrum disorder patients are MOG‐IgG positive? A cross sectional study of 132 patients. J Neurol. 2017;264:2088-2094.
    4. Prain K, Woodhall M, Vincent A, et al. AQP4 antibody assay sensitivity comparison in the era of the 2015 diagnostic criteria for NMOSD. Front Neurol. 2015;10:1-7.
    5. Waters PJ, Pittock SJ, Bennett JL, Jarius S, Weinshenker BG, Wingerchuk DM. Evaluation of aquaporin-4 antibody assays. Clin Exp Neuroimmunol. 2014;5(3):290-303.
    6. Jiao Y, Fryer JP, Lennon VA, et al. Updated estimate of AQP4-IgG serostatus and disability outcome in neuromyelitis optica. Neurology. 2013;81:1197-1204.
    7. Jarius S, Ruprecht K, Wildemann B, et al. Contrasting disease patterns in seropositive and seronegative neuromyelitis optica: A multicentre study of 175 patients. J Neuroinflammation. 2012;9(14):1-17.
    8. Majed M, Fryer JP, McKeon A, Lennon VA, Pittock SJ. Clinical utility of testing AQP4-IgG in CSF: guidance for physicians. Neurol Neuroimmunol Neuroinflamm. 2016;3:1-6. doi:10.1212/ NXI.0000000000000231
    9. Sato DK, Callegaro D, Lana-Peixoto MA, et al. Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders. Neurology. 2014;82:474-481.