Dual positivity for anti-MOG and oligoclonal bands: Unveiling unique clinical profiles and implications.

BACKGROUND: Distinguishing between MOG-associated disease (MOGAD) and multiple sclerosis (MS) presents a considerable challenge, as there are instances of overlapping clinical presentations. This complexity is further magnified in cases where patients concurrently exhibit both anti-myelin oligodendrocyte glycoprotein (anti-MOG) positivity and detectable oligoclonal bands (OCBs) This retrospective study investigates the clinical and imaging attributes of dual-positive patients, those with both anti-MOG positivity and OCBs, The study aims to show potential areas of overlap between multiple sclerosis (MS) and MOGAD. METHODS: Utilizing data gathered from three medical centers, we evaluated a cohort of 45 patients, stratifying them into two groups: those exclusively positive for anti-MOG antibodies and those displaying dual positivity. Our analysis encompassed a wide range of clinical and imaging parameters. The statistical techniques employed comprised Fisher's Exact Test along with Benjamini-Hochberg correction to ensure robustness of the findings. RESULTS: The study involved 45 patients with anti-MOG antibodies; 30 exhibited isolated anti-MOG positivity without OCBs, while 15 were dual-positive. The first group's average age was 10±7 years, compared to 28±17 years in the double-positive group (p = 0.001). CSF analysis showed no significant differences in pleocytosis, protein levels, or opening pressure between the groups. In the exclusive anti-MOG positivity cohort, 9 out of 15 patients received IVIG treatment; a larger subgroup with dual positivity chose anti-CD20 treatment. Notably, papilledema incidence was higher in the single-positive group (p = 0.014). Optic nerve enhancement (p = 0.0038) and nerve thickening (p = 0.0017) were markedly elevated in the single-positive population, with a trend towards pre-chiasmatic lesions (p = 0.06). Double-positive cases exhibited more polyfocal presentation (p = 0.013) and higher attacks per case (p = 0.002, HR=10.2, 95 % CI: 2.19 to 49.23). The double-positive group had more brain lesions (p = 0.0063) but no significant distinctions in other aspects. CONCLUSION: The results emphasize the challenges inherent in differentiating between MS and a more MOGAD. While the data suggest two plausible scenarios-either falling within the spectrum of MS or representing an intensified MOGAD-we recognize the need for stronger evidence to definitively classify these instances. This study underscores the imperative for thorough investigations to ascertain whether these cases align with the MS spectrum or denote an inflammatory variant of MOGAD.

[Sperm or oocyte donation: the dynamics of making the decision regarding the method and timing of disclosure of information to the sibling].

A dramatic increase in the number of children born as a result of gamete donation has occurred worldwide over the past decade. Concurrent to the acceleration in the use of gamete donation there has been a growing movement advocating non-anonymity in donor programs and disclosure to the offspring of donor gamete conceptions. The fact that current recommendations concerning gamete donation differ widely among various countries reflects the Lack of consensus around the world, especially in regard to two major issues: donor anonymity and the disclosure decision. In the past, the donors' identity was always kept anonymous, and they were ensured full secrecy. Recently, a 'double track' policy has become increasingly popular. Under this policy, the donor has the choice to enter the program as either an anonymous or an identifiable donor, while the recipient can choose between these two types of donors. This scheme allows the recipients to decide in the future the degree of disclosure that best meets their interest in involving the donor in their lives. The parent's decision regarding disclosure of gamete donation before the child reflects their general philosophy and their individual values regarding the way they manage their Lives, and specifically how they desire to fulfill their role as parents. Study resuLts show that individual counseling appeared to be helpfuL and appreciated by study participants. This is particuLarLy true when delivered without judgment or directive personal opinion. Peer support, often in the form of professionally-led groups, was most highly valued. It seems likely that peer support, not only reduces the sense of isolation and stigma by normalizing the donor experience, but facilitates information acquisition derived from the shared, personal, lived experiences of other parents in the same unique life situation.