Recognizing the Clinical Features of MOGAD for Diagnosis: Eoin P. Flanagan, MB, BCh

WATCH TIME: 4 minutes

"One thing we were highlighting is that in MOGAD, it doesn't tend to form scars, and the lesions often resolve, which is very different from MS."

Myelin oligodendrocyte glycoprotein (MOG)-associated disease (MOGAD) is a rare antibody-mediated inflammatory demyelinating disorder of the central nervous system. Although the clinical presentation of MOGAD might resemble neuromyelitis optica spectrum disorder (NMOSD), most experts regard it as a distinct condition with a different immune system pathology than NMOSD. MOG is a molecule on the outer membrane of myelin sheaths expressed in the brain, spinal cord, and optic nerves. Research shows that the specific outmost location of myelin makes it a potential target for autoimmune antibodies and cell-mediated responses in the demyelinating processes.¹

Accurate diagnosis of MOGAD relies on the identification of pathogenic MOG antibodies in the patient’s serum using precise and sensitive methods, preferably with optimized cell-based assays (CBA) as recommended by researchers.¹ MRI imaging can also aid in distinguishing MOGAD from other neuroinflammatory disorders such as multiple sclerosis (MS) and NMOSD. Despite the limited randomized controlled trials in MOGAD, reported observational data suggest that high-dose steroids and plasma exchange may help to treat acute attacks. Additionally, immunosuppressive therapies such as steroids, oral immunosuppressants, and rituximab are recommended by clinicians as a treatment for managing MOGAD.

Eoin P. Flanagan, MB, BCh, professor of neurology and chief of the Division of Multiple Sclerosis and Autoimmune Neurology at Mayo Clinic, presented on diagnostic clinical pearls for MOGAD at the 2024 Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 29 to June 1, in Nashville, Tennessee. At the meeting, Flanagan, who also serves as the director of the Autoimmune Neurology Fellowship, sat down in an interview with NeurologyLive^® to discuss the key differences between MOGAD and MS in terms of lesion formation and resolution. He also spoke about how spinal fluid testing can be useful in diagnosing MOGAD when serum tests are inconclusive. In addition, he spoke about the current state of treatment options for MOGAD compared with NMOSD.

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REFERENCES
1. Ambrosius W, Michalak S, Kozubski W, Kalinowska A. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: Current Insights into the Disease Pathophysiology, Diagnosis and Management. Int J Mol Sci. 2020;22(1):100. Published 2020 Dec 24. doi:10.3390/ijms22010100