Overview
Diagnosis
A healthcare professional reviews your symptoms and medical history and may perform a physical examination to look for signs of myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD).
MOGAD is usually diagnosed after two key points are confirmed. First, symptoms must reflect a typical attack, such as optic neuritis, transverse myelitis, or acute disseminated encephalomyelitis. Second, MOG antibodies must be detected in the blood or spinal fluid.
These confirmations are made using several diagnostic procedures:
MOG antibody testing
A cell-based assay is used to detect MOG antibodies in the blood by examining cells that have MOG on their surface. This test is considered the gold standard for diagnosing MOGAD. However, false positives can occur, especially if symptoms are not typical or resemble other conditions such as multiple sclerosis.
Spinal tap
Also known as a lumbar puncture, this test involves collecting a small sample of cerebrospinal fluid. It can show an increased white blood cell count, which indicates inflammation and is common in MOGAD. The test may also detect oligoclonal bands, which are more typical of multiple sclerosis and can help distinguish between the two diseases.
Imaging tests
MRI scans of the brain, spinal cord, and optic nerves may be performed. These images can reveal lesions in the brain or spinal cord and inflammation of the optic nerve.
Eye examination
Optical coherence tomography is an eye test that measures the layers of the retina. During optic neuritis, the retina may appear thicker than usual. After repeated attacks, retinal thinning may occur due to nerve damage.
MOG antibody testing is not always definitive. Sometimes healthy individuals or people with other neurological conditions may have low levels of MOG antibodies. Your healthcare team carefully interprets test results to rule out other possible causes of symptoms.
Treatment
There is no cure for MOGAD. Treatment focuses on speeding recovery from attacks, managing ongoing symptoms, and reducing the risk of future attacks. Your healthcare team works with you to develop a treatment plan based on your specific needs.
Treatment for attacks
MOGAD attacks are often severe and should be treated promptly to improve recovery. Treatment options may include:
Corticosteroids
These medicines reduce inflammation of the nerves and can quickly improve symptoms. They are usually given in high doses, either by mouth or through an IV. Possible side effects include sleep problems, increased blood pressure and blood sugar, mood changes, and fluid retention.
Plasma exchange
This procedure removes the plasma portion of the blood, which contains MOG antibodies, and replaces it with a protein solution before returning the blood to the body. Plasma exchange may be used if symptoms are severe, new, or do not improve with corticosteroids.
IV immune globulin
Also called IVIG, this treatment uses antibodies from donated plasma to neutralize MOG antibodies and reduce inflammation. IVIG also suppresses the immune system and may help prevent future attacks. It is more commonly used in children.
Treatment for symptoms
Managing symptoms after an attack can help improve comfort and daily function. Treatment options may include:
Antiseizure medicines
Some people with MOGAD experience seizures. These medicines reduce seizure frequency and help prevent recurrence.
Therapies
Physical therapy and occupational therapy can help restore strength, movement, and function after attacks that cause weakness, stiffness, or paralysis.
Other medicines
Additional medications may be prescribed to treat pain, fatigue, bowel and bladder problems, or erectile dysfunction related to MOGAD.
Treatment to prevent attacks
Because MOGAD is a recently identified condition, there are no definitively proven treatments to prevent attacks. Ongoing research and clinical trials are exploring preventive options.
Preventive treatment is usually considered only in people with relapsing MOGAD, meaning more than one attack. These treatments suppress the immune system to reduce the risk of future attacks but may increase the risk of infection and other complications.
Prevention treatment may be started after a second attack or after a first attack if it caused severe or permanent damage.
Treatment options may include:
Oral immunosuppressants
Medicines such as azathioprine, mycophenolate mofetil, and prednisone suppress the immune system and reduce damage to myelin. These medicines may take several months to become effective and can have side effects such as infection, rash, and increased cancer risk with long-term use.
IV medicines
IV immune globulin may be used for long-term prevention. Other IV medicines, such as rituximab or tocilizumab, may also be prescribed to suppress immune activity. Side effects can include headache and increased risk of infection.
The choice and duration of preventive treatment depend on effectiveness, side effects, and individual health factors. Your healthcare team helps balance benefits and risks to determine the best long-term approach.
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