Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease

This article reviews the clinical features, MRI attributes, serologic aspects, diagnostic criteria, treatment, and prognosis of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).

The discovery of the MOG antibody as a diagnostic biomarker has allowed for the identification of a new inflammatory demyelinating disease of the central nervous system, distinct from multiple sclerosis and neuromyelitis optica spectrum disorder (NMOSD). Our knowledge of MOGAD's clinical and MRI manifestations is growing rapidly. While children are predisposed to MOGAD, the disease is spread broadly across the age spectrum. The MOG antibody is best assessed in serum using a cell-based assay technique and is highly specific; however, caution is needed with low-positive results, which can occur in other disorders. The recent publication of international consensus diagnostic criteria for MOGAD in 2023 defined the disease, and subsequent validation studies suggest the criteria work well when applied in clinical practice. The acute treatment of MOGAD attacks includes high-dose IV corticosteroids and plasmapheresis for symptoms refractory to corticosteroids. Maintenance treatment decisions require careful consideration, as up to 50% of patients have a monophasic disease course and may not require ongoing treatment. On the other hand, those with a relapsing course or severe first attack with poor recovery may benefit from empiric attack-prevention treatments. While class 1 data on medications to prevent attacks in MOGAD are lacking, clinical trials are now underway that could guide our therapeutic approach in the future.

Familiarity with the clinical, MRI, CSF, and serologic features of MOGAD can help neurologists recognize this condition in clinical practice. Awareness of the utility and pitfalls of the MOG antibody test is critical. The current therapeutic approach is guided by retrospective studies and the application of immunotherapies used in other autoimmune neurologic disorders.