Pregnancy Management in NMO: A Case of MOG- Antibody Positive NMO and Literature Review

Neuromyelitis optica (NMO) is a rare but severely disabling disease, affecting predominantly the optic nerves and spinal cord. Aquaporin-4 (AQP4 IgG) antibodies have been described as characteristic and pathogenic for the disease. Some NMO cases are AQP4 IgG negative, of which a fraction has antibodies against myelin oligodendrocyte glycoprotein (MOG). We report the pregnancy of a 42 year old English woman who was diagnosed with neuromyelitis optica spectrum disorder (NMOSD), with anti-MOG antibodies. She fell pregnant prior to starting immunosuppressive therapy. At week 30 of gestation, she experienced a relapse and was treated with high dose steroids. She developed further right hand numbness in the week post-partum and had MRI confirmation of a new cervical lesion. This case suggests that unlike in multiple sclerosis (MS), pregnancy does not protect from relapses in NMO. Here we review the limited experience of pregnancy outcomes in anti-MOG antibodies positive NMO patients.