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Prevalence and incidence of neuromyelitis optica spectrum disorder, aquaporin-4 antibody-positive NMOSD and MOG antibody-positive disease in Oxfordshire, UK
  1. Karen O'Connell1,
  2. Antonia Hamilton-Shield1,
  3. Mark Woodhall1,
  4. Silvia Messina1,
  5. Romina Mariano1,
  6. Patrick Waters1,
  7. Sithara Ramdas2,
  8. Maria Isabel Leite1,
  9. Jacqueline Palace2
  1. 1 Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
  2. 2 Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
  1. Correspondence to Dr Karen O'Connell, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, Oxfordshire OX3 9DU, UK; kazzoc{at}

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Neuromyelitis optica spectrum disorders (NMOSDs) are a group of rare, inflammatory, demyelinating diseases that affect the central nervous system. Aquaporin-4-IgG (AQP-4-IgG) is detectable in over 70% of patients and plays a critical role in diagnosis.1 According to 2015 International Panel for NMO Diagnosis (IPND) criteria, patients seronegative for AQP-4-IgG can still be diagnosed with NMOSD but must meet more stringent clinical and radiological criteria.1 A subset of this group may be positive for myelin oligodendrocyte glycoprotein antibodies (MOG-Abs).2 MOG-Ab disease encompasses a broader clinical spectrum, including isolated optic neuritis (ON, often bilateral and recurrent), isolated transverse myelitis (TM) and acute demyelinating encephalomyelitis (ADEM) (online supplementary figure 1). This, coupled with a monophasic course in half and high recovery rates without residual disability, has led many to argue MOG-Ab disease should be considered a separate entity from AQP-4-IgG NMOSD.

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Previous epidemiology studies have varied in relation to case ascertainment, diagnostic criteria used, age restrictions among study populations, and reporting and testing of antibodies, making cross-comparisons difficult. Limiting studies to those using the updated 2015 IPND criteria,1 prevalence and incidence rates of NMOSD, among predominantly Caucasian populations, range from 0.7 to 1.87/100 000 and 0.3–1.2/million person-years.3–6 The epidemiology of MOG-Ab disease is largely unknown.

Given the rarity of these conditions, evolving diagnostic criteria and recent availability of accurate antibody testing, these rates likely underestimate the true prevalence and incidence. Thus, in the current study, we sought to calculate the respective prevalence and incidence of NMOSD, AQP-4-IgG-positive NMOSD and MOG-Ab disease in Oxfordshire.


This cohort study was conducted using a prospectively collected dataset of patients (adult and paediatric) attending the NHS National Specialised Services for Neuromyelitis Optica, in Oxford. All neurologists practising at our …

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  • Contributors KOC: data collection and analysis and draft of manuscript. AH-S: data collection and analysis and review of final manuscript. MW and PW: laboratory data collection, analysis and critical appraisal of final manuscript. SM, RM, SR and MIL: data collection and critical appraisal of final manuscript. JP project conception and design and critical appraisal of the final manuscript.

  • Funding We gratefully acknowledge the Highly Specialised Commissioning Team of the National Health Service for funding the Neuromyelitis Optica service in Oxford.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All patients involved in this study, signed written consent of the NMO Tissue Bank (Oxford Research Ethics Committee C Ref: 10/H0606/56).

  • Provenance and peer review Not commissioned; externally peer reviewed.