Myelin oligodendrocyte glycoprotein (MOG) antibody disease (MOGAD) is an autoimmune disorder that shares some symptoms with multiple sclerosis and may be misdiagnosed as MS. It is associated with the presence of antibodies directed against MOG. MOG is found in the myelin that insulates the nerves of the central nervous system (CNS), which consists of the brain, spinal cord and optic nerves. Damage to myelin causes disruption in the transmission of nerve signals in the body and a variety of symptoms.
Changes in vision (optic neuritis) and symptoms caused by spinal cord inflammation (transverse myelitis) are common in MOGAD.
Symptoms caused by optic neuritis include:
- Loss or blurring of vision in one or both eyes
- Loss of color vision
- Eye pain
Symptoms caused by transverse myelitis include:
- Weakness, numbness or loss of sensation
- Loss of bowel or bladder control or difficulty emptying the bladder
- Spasticity (increased muscle tone or stiffness in the arms or legs)
- Shooting pain or tingling in the neck, back or abdomen
In children (rarely in adults) with MOGAD, it is possible to develop acute disseminated encephalomyelitis (ADEM)
. Symptoms of ADEM include:
- Changes in vision
- Loss of balance
Tools for diagnosing MOGAD
A diagnosis of MOGAD is generally made when you have:
- MOG-antibody in your blood, and
- Certain other demyelinating disorders, such as optic neuritis, transverse myelitis or acute disseminated encephalomyelitis (ADEM)
The process of diagnosis includes:
- A medical history to identify any past or present symptoms that might be caused by MOGAD, neuromyelitis optica spectrum disorder (NMOSD), MS or a different condition
- Neurologic exam of your thinking, vision, hearing, sensations, strength, swallowing, reflexes, coordination, walking and balance
- MRI of your brain, optic nerves and spinal cord
- Spinal tap (lumbar puncture) to examine cerebrospinal fluid
- Eye scans and vision tests
- Blood tests
We are still learning about the total number of people living with MOGAD.
- MOGAD seems to be equally common among men and women.
- MOGAD presents in both adults and in children.
- MOGAD presents differently in adults and in children.
- In children, MOGAD more commonly causes attacks on the brain, resulting in symptoms like confusion, incoordination, double vision, nausea and vomiting.
- In adults, MOGAD often causes damage to the eyes (optic neuritis) and/or spinal cord (transverse myelitis).
- There is no clear ethnic association with MOGAD.
How is MOGAD related to neuromyelitis optica spectrum disorder (NMOSD) and MS?
MOGAD, like MS and NMOSD, is a demyelinating disease of the CNS. However, it is different from these other conditions:
- MOGAD and NMOSD frequently affect both eyes at the same time and cause more severe visual loss compared to MS. There is often better recovery of vision in MOGAD than in NMOSD.
- MOGAD is equally common in men and women, whereas women are more likely to develop both MS and NMOSD.
- In children, MOGAD may cause attacks of the brain rather than the eye or spinal cord. These attacks are called “acute disseminated encephalomyelitis” or “ADEM.”
- People with MOGAD often have an excellent response to steroids and recover much of their function from before an attack.
- After the first attack, about half of people with MOGAD may have no further attacks, unlike people with NMOSD and MS, who are very likely to have further relapses.
There are several treatments for acute attacks of MOGAD:
- Intravenous (infusion through the vein) high-dose steroids are given to reduce the inflammation of the brain, optic nerve and spinal cord.
- Intravenous immunoglobulin (IVIG) is a treatment made from purified antibodies from healthy blood plasma donations. Plasma is the liquid part of the blood. The medication is given through a drip infusion through a vein in your arm and takes several hours to complete. IVIG has been shown to reduce the activity in certain immune diseases by decreasing inflammation.
- Plasma Exchange (PLEX) can be used for severe attacks or if no improvement occurs with high-dose steroids. The goal of PLEX is to lower the level of anti-MOG antibodies in the blood. PLEX involves removing blood from the body through a needle and tubing. Through a series of steps, the plasma is separated from blood cells and replaced with an artificial plasma substitute. The plasma substitute and blood cells are combined and returned to the body through an intravenous line. The procedure lasts several hours and may be repeated multiple times over a number of days.
No treatments for MOGAD have been approved by the Food and Drug Administration (FDA). If patients have more than one attack, they may require long-term treatment to prevent further attacks. Several medications that have FDA approval for other diseases may be prescribed — called “off-label” use — to prevent attacks:
- Azathioprine (Azasan® and Imuran®)
- Immunoglobulin (either intravenous infusion or subcutaneous injection)
- Mycophenolate mofetil (Cellcept®)
- Rituximab (Rituxan®) and biosimilars
- Tocilizumab (Actemra®)
If your health insurer denies the MOGAD treatment recommended by your healthcare provider, consider connecting to the Patient Advocate Foundation for assistance with appealing that decision.
- The MOG Project — The MOG Project is a nonprofit organization that advocates for people diagnosed with MOGAD by raising awareness, providing information and supporting research to find a cure. It also offers support groups to the MOGAD community.
- The Siegel Rare Neuroimmune Association (SRNA) is a nonprofit organization dedicated to the support of people with ADEM, MOGAD, NMOSD, optic neuritis and transverse myelitis. They support individuals living with these diseases and their families, maintain a clinical care network and fund research.
- Ask an MS Navigator — While The MOG Project and SRNA are the best resources for information and research on MOGAD, our MS Navigator team can provide help with understanding health insurance, resources for facing financial challenges and assessments for personalized case management.
Reviewed by Shuvro Roy, MD, and Elias Sotirchos, MD, August 2022.