Frequency of the Supporting Features for MOGAD Diagnosis in Patients with Multiple Sclerosis
Pietro Zara1, Stefania Leoni1, Sara Etzi2, Sabrine Othmani1, Valentina Floris1, Maria Margherita Sechi2, Rosa Cortese3, Matteo Gastaldi4, Sara Mariotto5, Stefano Sotgiu2, Paolo Solla1, Elia Sechi1
1University Hospital of Sassari, 2Child Neurology Unit, University Hospital of Sassari; Sassari, Italy, University Hospital of Sassari, 3Department of Medicine, Surgery and Neuroscience, University of Siena; Siena, Italy, University of Siena, 4Neuroimmunology Laboratory and Research Section, IRCCS Mondino Foundation; Pavia, Italy, IRCCS Mondino Foundation, 5University of Verona
Objective:
To assess the frequency of the supporting features for myelin oligodendrocyte
glycoprotein antibody-associated disease (MOGAD) diagnosis in patients with multiple
sclerosis/clinically isolated syndrome (MS/CIS).
Background:
Supporting clinical/MRI features are required to diagnose MOGAD in patients at
high risk of false MOG-IgG positivity (low/unavailable titer, CSF-restricted), to help differentiation
from mimics, primarily MS. The proportion of MS/CIS patients showing MOGAD supporting
features is unknown.
Design/Methods:
We retrospectively identified patients diagnosed at the University Hospital of Sassari
(January 2021-September 2024) with: 1) Relapsing-remitting MS/CIS (2017 McDonald criteria);
and 2) brain/spinal cord MRI obtained ≤6 weeks of the presenting attack. Patients with MOGAD
(n=6) or other relapsing demyelinating CNS disorders (isolated optic neuritis/myelitis, n=8;
aquaporin-4-IgG+NMOSD, n=5; other, n=3) were excluded. The frequency of the MOGAD
supporting features was assessed in the symptomatic CNS region (optic nerve, brain/brainstem
and/or spinal cord), and compared with alternative features typical of MOGAD.
Results:
A total of 110 patients with MS/CIS were included. Median age was 35 (range, 6-78)
years; 12(11%) were children. The symptomatic CNS regions were: brain/brainstem (n=45), spinal
cord (n=37), and optic nerves (n=31). MOGAD supporting features (≥1) were less common in
patients with MS/CIS (24/110[25%]) than other excluded relapsing demyelinating CNS disorders
(11/16[69%]); p<0.001. In patients with MS/CIS, the most represented supporting features were:
centrally located spinal T2-lesions (11/21[52%]); longitudinally extensive optic nerve abnormalities
(3/29[10%]), conus involvement (3/34[9%]), and deep grey nuclei involvement (4 /45[9%]).
Bilateral/simultaneous optic neuritis and diffuse cortical involvement were the least common (0%).
Alternative typical MOGAD features not observed in MS/CIS were: presence of encephalopathy,
CSF pleocytosis >50 cells, and complete resolution of MRI abnormalities.
Conclusions:
MOGAD supporting features are not uncommon in patients with MS/CIS, with a
variable feature-specific frequency (0-52%). Awareness of this variability may help reduce
misdiagnoses and inform future refinements of the MOGAD diagnostic criteria.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.