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Applying the Supporting Features for MOGAD Diagnosis to Patients With Multiple Sclerosis.
Pietro Zara1, Giacomo Greco2, Francesco Masi3
1Neurology Unit, Department of Medicine, Surgery and Pharmacy, University Hospital of Sassari, Italy.
Neurology(R) Neuroimmunology & Neuroinflammation
|October 8, 2025
Summary
The study found that while 27% of patients with multiple sclerosis (MS) or clinically isolated syndrome (CIS) show features supporting myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), the actual risk of misdiagnosis remains low. This highlights the need to refine MOGAD diagnostic criteria for better differentiation from MS.
Area of Science:
- Neuroimmunology
- Clinical Neurology
- Diagnostic Criteria Development
Background:
- Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) diagnosis requires supporting features to differentiate from multiple sclerosis (MS), especially with low MOG-IgG titers.
- Overlapping features between MOGAD and MS necessitate understanding MOGAD feature frequency at MS onset to prevent misdiagnosis.
Purpose of the Study:
- To assess the frequency of MOGAD supporting features during the initial presentation of MS or clinically isolated syndrome (CIS).
- To determine the potential risk of misdiagnosing MS/CIS as MOGAD based on MOGAD supporting features and false-positive MOG-IgG results.
Main Methods:
- Retrospective observational study of 244 patients with relapsing-remitting MS/CIS and available first-attack MRI.
- Assessed frequency of MOGAD supporting features and evaluated risk of misdiagnosis considering false MOG-IgG positivity.
- Examined other MOGAD-typical features not in current diagnostic criteria.
Main Results:
- 27% of MS/CIS patients exhibited at least one MOGAD supporting feature at presentation.
- "Central cord lesion" (33%) and "deep gray nuclei involvement" (28%) were the most common features.
- The combined probability of false MOG-IgG positivity and meeting a MOGAD supporting feature was low (0.4%).
Conclusions:
- MOGAD supporting features occur in a significant minority of MS/CIS patients at onset, but the overall risk of misdiagnosis is low.
- Future MOGAD diagnostic criteria refinements should consider feature frequency in MS/CIS and incorporate more specific clinical-MRI markers.
