MOGAD
Diagnosis
There are blood tests that can test for MOG antibodies. Only cell-based assays are considered reliable for the diagnosis of MOGAD because of the improved specificity over older ELISA tests.2 CSF analysis from a lumbar puncture may show increased white blood cell counts during a relapse, and oligoclonal bands are not usually found.5
In rare cases, some individuals may test positive for both MOG and AQP-4 antibodies. However, in these cases, they have a disease course consistent with AQP-4 positive NMOSD.4
MOGAD is most often diagnosed when someone has a positive blood test for the MOG antibody and also presents with one of the above-mentioned clinical inflammatory attacks. Other disorders, especially MS, need to be ruled out before diagnosing someone with MOGAD.4
MRI findings may be similar to those seen in MS and NMOSD, but there are important differences. For example, in MOG antibody disease, optic neuritis often affects both eyes, involves the front-most portion of the optic nerve, and is associated with swelling of the optic disc. Furthermore, MOGAD lesions in the brain tend to look fluffy and poorly-defined, occur in the deep gray matter or white matter, and occur on both sides of the brain.4
(2) Kezuka T, Ishikawa H. Diagnosis and treatment of anti-myelin oligodendrocyte glycoprotein antibody positive optic neuritis. Jpn J Ophthalmol. 2018 Mar;62(2):101-108. doi: 10.1007/s10384-018-0561-1. Epub 2018 Feb 14.
(4) Banwell B, Bennett JL, Marignier R, et al. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. Lancet Neurol. 2023 Mar;22(3):268-282. doi: 10.1016/S1474-4422(22)00431-8. Epub 2023 Jan 24.
(5) Weber MS, Derfuss T, Metz I, Brück W. Defining distinct features of anti-MOG antibody associated central nervous system demyelination. Ther Adv Neurol Disord. 2018 Mar 29;11:1756286418762083. doi: 10.1177/1756286418762083. eCollection 2018.
