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NMOSD and MOGAD: Updates on diagnostic criteria.

R Marignier¹, M Leal Rato²

¹Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), service sclérose en plaques, pathologie de la myeline et neuro-inflammation, hôpital neurologique Pierre-Wertheimer, hospices civils de Lyon, Lyon, France.

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|April 2, 2026

Summary

Updated diagnostic criteria for demyelinating diseases like multiple sclerosis emphasize imaging and fluid markers. New guidelines for neuromyelitis optica (NMO) and MOG-antibody associated disease (MOGAD) require accurate AQP4-IgG testing and expert review.

Keywords:

Assay Diagnostic criteria MOGAD NMOSD Seronegative NMO

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Area of Science:

Neurology
Immunology
Diagnostic Medicine

Background:

Recent advancements in understanding demyelinating diseases necessitate updated diagnostic criteria.
Imaging and fluid biomarkers are increasingly crucial for accurate diagnosis.
Distinguishing between related neurological conditions is essential for effective treatment.

Purpose of the Study:

To review the impact and limitations of updated diagnostic criteria for demyelinating diseases.
To highlight key changes in criteria for neuromyelitis optica (NMO) and MOG-antibody associated disease (MOGAD).
To emphasize the importance of AQP4-IgG status determination and expert clinical review.

Main Methods:

Review of recent literature and guideline updates for demyelinating diseases.
Analysis of clinico-radiological changes in diagnostic criteria.
Discussion of serological markers and their diagnostic significance.

Main Results:

New NMO criteria incorporate clinico-radiological updates and stress AQP4-IgG testing.
Seronegative NMO is now recognized as distinct from AQP4-IgG disease.
MOGAD criteria validation shows a need for expert case-by-case review due to limitations.

Conclusions:

Updated diagnostic criteria for demyelinating diseases offer significant advancements.
Accurate AQP4-IgG testing and expert interpretation are vital for precise diagnosis.
Ongoing evaluation of criteria is necessary to address clinical application challenges.