MOGAD AS AN EMERGING CHALLENGE IN MODERN HEALTHCARE: FROM IMMUNOLOGY TO FUNCTIONAL RECOVERY
DOI:
https://doi.org/10.31435/ijitss.2(50).2026.5742Keywords:
MOGAD, Anti- Mog, Mog Antibody Disease, Myelin Oligodendrocyte Glycoprotein AntibodyAbstract
Background. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently defined autoimmune demyelinating disorder of the central nervous system, characterized by antibodies against myelin oligodendrocyte glycoprotein (MOG).
Aim. The aim of this review is to systematize the most recent evidence regarding the MOGAD
Material and Methods. A systematic literature review was conducted through a comprehensive search of databases (via the PubMed and Google Scholar platforms)
Results. MOGAD may occur at any age, most frequently between 20 and 40 years, with variable epidemiological patterns. The clinical spectrum includes optic neuritis, transverse myelitis, acute disseminated encephalomyelitis (ADEM), cortical encephalitis, and brainstem or cerebellar involvement. Age-related phenotypic differences are observed, with ADEM predominating in children and optic neuritis being more common in adults. Biomarkers such as serum MOG-IgG titers, cerebrospinal fluid (CSF) leukocytosis, and oligoclonal band status may reflect disease activity and help predict relapse risk. Persistent seropositivity is associated with a higher likelihood of recurrence, whereas transient positivity correlates with a more favorable course. Acute management primarily includes high-dose corticosteroids, intravenous immunoglobulins (IVIG), and plasma exchange (PLEX). Long-term treatment involves immunomodulatory or immunosuppressive therapies, with oral corticosteroids and IVIG demonstrating the best balance of efficacy and tolerability.
Conclusions. MOGAD represents a distinct immunological entity with specific clinical, radiological, and serological features. Ongoing research continues to refine diagnostic criteria, biomarkers, and therapeutic strategies, improving disease recognition and management.
References
Andersen, J., & Brilot, F. (2025). Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): Insights into pathogenesis and biomarkers of prognosis. Seminars in Immunology, 78, 101944. https://doi.org/10.1016/j.smim.2025.101944
Andersen, J., Trewin, B. P., Dale, R. C., Ramanathan, S., & Brilot, F. (2025). Biomarkers to predict relapse in myelin oligodendrocyte glycoprotein antibody-associated disease: A systematic review and meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry. Advance online publication. https://doi.org/10.1136/jnnp-2025-337039
Armangue, T., Olivé-Cirera, G., Martínez-Hernandez, E., Sepulveda, M., Ruiz-Garcia, R., Muñoz-Batista, M., Ariño, H., González-Álvarez, V., Felipe-Rucián, A., Jesús Martínez-González, M., Cantarín-Extremera, V., Concepción Miranda-Herrero, M., Monge-Galindo, L., Tomás-Vila, M., Miravet, E., Málaga, I., Arrambide, G., Auger, C., Tintoré, M., ... Villar-Vera, C. (2020). Associations of paediatric demyelinating and encephalitic syndromes with myelin oligodendrocyte glycoprotein antibodies: A multicentre observational study. The Lancet Neurology, 19(3), 234–246. https://doi.org/10.1016/S1474-4422(19)30488-0
Asseyer, S., Cooper, G., & Paul, F. (2020). Pain in NMOSD and MOGAD: A systematic literature review of pathophysiology, symptoms, and current treatment strategies. Frontiers in Neurology, 11, 778. https://doi.org/10.3389/fneur.2020.00778
Banwell, B., Bennett, J. L., Marignier, R., Kim, H. J., Brilot, F., Flanagan, E. P., Ramanathan, S., Waters, P., Tenembaum, S., Graves, J. S., Chitnis, T., Brandt, A. U., Hemingway, C., Neuteboom, R., Pandit, L., Reindl, M., Saiz, A., Sato, D. K., Rostasy, K., ... Palace, J. (2023). Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. The Lancet Neurology, 22(3), 268–282. https://doi.org/10.1016/S1474-4422(22)00431-8
Cacciaguerra, L., & Flanagan, E. P. (2024). Updates in NMOSD and MOGAD diagnosis and treatment. Neurologic Clinics, 42(1), 77–114. https://doi.org/10.1016/j.ncl.2023.06.009
Chen, J. J., Flanagan, E. P., Jitprapaikulsan, J., López-Chiriboga, A. S. S., Fryer, J. P., Leavitt, J. A., Weinshenker, B. G., McKeon, A., Tillema, J.-M., Lennon, V. A., Tobin, W. O., Keegan, B. M., Lucchinetti, C. F., Kantarci, O. H., McClelland, C. M., Lee, M. S., Bennett, J. L., Pelak, V. S., Chen, Y., ... Pittock, S. J. (2018). Myelin oligodendrocyte glycoprotein antibody–positive optic neuritis: Clinical characteristics, radiologic clues, and outcome. American Journal of Ophthalmology, 195, 8–15. https://doi.org/10.1016/j.ajo.2018.07.020
Ciron, J., Cobo-Calvo, A., Audoin, B., Bourre, B., Brassat, D., Cohen, M., Collongues, N., Deschamps, R., Durand-Dubief, F., Laplaud, D., Maillart, E., Papeix, C., Zephir, H., Bereau, M., Brochet, B., Carra-Dallière, C., Derache, N., Gagou-Scherer, C., Henry, C., ... Marignier, R. (2020). Frequency and characteristics of short versus longitudinally extensive myelitis in adults with MOG antibodies: A retrospective multicentric study. Multiple Sclerosis Journal, 26(8), 936–944. https://doi.org/10.1177/1352458519849511
Cobo-Calvo, A., Ruiz, A., Maillart, E., Audoin, B., Zephir, H., Bourre, B., Ciron, J., Collongues, N., Brassat, D., Cotton, F., Papeix, C., Durand-Dubief, F., Laplaud, D., Deschamps, R., Cohen, M., Biotti, D., Ayrignac, X., Tilikete, C., Thouvenot, E., ... Desille-Dugast, M. (2018). Clinical spectrum and prognostic value of CNS MOG autoimmunity in adults: The MOGADOR study. Neurology, 90(21), e1858–e1869. https://doi.org/10.1212/WNL.0000000000005560
Cortese, R., Battaglini, M., Prados, F., Bianchi, A., Haider, L., Jacob, A., Palace, J., Messina, S., Paul, F., Wuerfel, J., Marignier, R., Durand-Dubief, F., De Medeiros Rimkus, C., Callegaro, D., Sato, D. K., Filippi, M., Rocca, M. A., Cacciaguerra, L., Rovira, A., ... Yousry, T. (2023a). Clinical and MRI measures to identify non-acute MOG-antibody disease in adults. Brain, 146(6), 2489–2501. https://doi.org/10.1093/brain/awac480
Cortese, R., Battaglini, M., Prados, F., Bianchi, A., Haider, L., Jacob, A., Palace, J., Messina, S., Paul, F., Wuerfel, J., Marignier, R., Durand-Dubief, F., De Medeiros Rimkus, C., Callegaro, D., Sato, D. K., Filippi, M., Rocca, M. A., Cacciaguerra, L., Rovira, A., ... Yousry, T. (2023b). Clinical and MRI measures to identify non-acute MOG-antibody disease in adults. Brain, 146(6), 2489–2501. https://doi.org/10.1093/brain/awac480
Dubey, D., Pittock, S. J., Krecke, K. N., Morris, P. P., Sechi, E., Zalewski, N. L., Weinshenker, B. G., Shosha, E., Lucchinetti, C. F., Fryer, J. P., Lopez-Chiriboga, A. S., Chen, J. C., Jitprapaikulsan, J., McKeon, A., Gadoth, A., Keegan, B. M., Tillema, J.-M., Naddaf, E., Patterson, M. C., ... Flanagan, E. P. (2019). Clinical, radiologic, and prognostic features of myelitis associated with myelin oligodendrocyte glycoprotein autoantibody. JAMA Neurology, 76(3), 301–309. https://doi.org/10.1001/jamaneurol.2018.4053
Duchow, A., Bellmann‐Strobl, J., Friede, T., Aktas, O., Angstwurm, K., Ayzenberg, I., Berthele, A., Dawin, E., Engels, D., Fischer, K., Flaskamp, M., Giglhuber, K., Grothe, M., Havla, J., Hümmert, M. W., Jarius, S., Kaste, M., Kern, P., Kleiter, I., ... Neuromyelitis Optica Study Group. (2024). Time to disability milestones and annualized relapse rates in NMOSD and MOGAD. Annals of Neurology, 95(4), 720–732. https://doi.org/10.1002/ana.26858
Flanagan, E. P. (2019). Neuromyelitis optica spectrum disorder and other non–multiple sclerosis central nervous system inflammatory diseases. Continuum, 25(3), 815–844. https://doi.org/10.1212/CON.0000000000000742
Hacohen, Y., & Banwell, B. (2019). Treatment approaches for MOG-Ab-associated demyelination in children. Current Treatment Options in Neurology, 21(1), 2. https://doi.org/10.1007/s11940-019-0541-x
Höftberger, R., Guo, Y., Flanagan, E. P., Lopez-Chiriboga, A. S., Endmayr, V., Hochmeister, S., Joldic, D., Pittock, S. J., Tillema, J. M., Gorman, M., Lassmann, H., & Lucchinetti, C. F. (2020). The pathology of central nervous system inflammatory demyelinating disease accompanying myelin oligodendrocyte glycoprotein autoantibody. Acta Neuropathologica, 139(5), 875–892. https://doi.org/10.1007/s00401-020-02132-y
Hor, J. Y., & Fujihara, K. (2023). Epidemiology of myelin oligodendrocyte glycoprotein antibody-associated disease: A review of prevalence and incidence worldwide. Frontiers in Neurology, 14, 1260358. https://doi.org/10.3389/fneur.2023.1260358
Huda, S., Whittam, D., Jackson, R., Karthikeayan, V., Kelly, P., Linaker, S., Mutch, K., Kneen, R., Woodhall, M., Murray, K., Hunt, D., Waters, P., & Jacob, A. (2021). Predictors of relapse in MOG antibody associated disease: A cohort study. BMJ Open, 11(11), e055392. https://doi.org/10.1136/bmjopen-2021-055392
Jarius, S., Ruprecht, K., Kleiter, I., Borisow, N., Asgari, N., Pitarokoili, K., Pache, F., Stich, O., Beume, L.-A., Hümmert, M. W., Ringelstein, M., Trebst, C., Winkelmann, A., Schwarz, A., Buttmann, M., Zimmermann, H., Kuchling, J., Franciotta, D., ... Wildemann, B., in cooperation with the Neuromyelitis Optica Study Group. (2016). MOG-IgG in NMO and related disorders: A multicenter study of 50 patients. Part 2: Epidemiology, clinical presentation, radiological and laboratory features, treatment responses, and long-term outcome. Journal of Neuroinflammation, 13(1), 280. https://doi.org/10.1186/s12974-016-0718-0
Jarius, S., & Wildemann, B. (2013). The history of neuromyelitis optica. Journal of Neuroinflammation, 10(1), 8. https://doi.org/10.1186/1742-2094-10-8
Jurynczyk, M., Messina, S., Woodhall, M. R., Raza, N., Everett, R., Roca-Fernandez, A., Tackley, G., Hamid, S., Sheard, A., Reynolds, G., Chandratre, S., Hemingway, C., Jacob, A., Vincent, A., Leite, M. I., Waters, P., & Palace, J. (2017). Clinical presentation and prognosis in MOG-antibody disease: A UK study. Brain, 140(12), 3128–3138. https://doi.org/10.1093/brain/awx276
Lennon, V. A., Kryzer, T. J., Pittock, S. J., Verkman, A. S., & Hinson, S. R. (2005). IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel. The Journal of Experimental Medicine, 202(4), 473–477. https://doi.org/10.1084/jem.20050304
Lennon, V. A., Wingerchuk, D. M., Kryzer, T. J., Pittock, S. J., Lucchinetti, C. F., Fujihara, K., Nakashima, I., & Weinshenker, B. G. (2004). A serum autoantibody marker of neuromyelitis optica: Distinction from multiple sclerosis. The Lancet, 364(9451), 2106–2112. https://doi.org/10.1016/S0140-6736(04)17551-X
Nagireddy, R. B. R., Kumar, A., Singh, V. K., Prasad, R., Pathak, A., Chaurasia, R. N., Mishra, V. N., & Joshi, D. (2021). Clinicoradiological comparative study of aquaporin-4-IgG seropositive neuromyelitis optica spectrum disorder (NMOSD) and MOG antibody associated disease (MOGAD): A prospective observational study and review of literature. Journal of Neuroimmunology, 361, 577742. https://doi.org/10.1016/j.jneuroim.2021.577742
Nakamura, M., Ogawa, R., Fujimori, J., Uzawa, A., Sato, Y., Nagashima, K., Kuriyama, N., Kuwabara, S., & Nakashima, I. (2023). Epidemiological and clinical characteristics of myelin oligodendrocyte glycoprotein antibody-associated disease in a nationwide survey. Multiple Sclerosis Journal, 29(4–5), 530–539. https://doi.org/10.1177/13524585231156736
O’Connor, K. C., McLaughlin, K. A., De Jager, P. L., Chitnis, T., Bettelli, E., Xu, C., Robinson, W. H., Cherry, S. V., Bar-Or, A., Banwell, B., Fukaura, H., Fukazawa, T., Tenembaum, S., Wong, S. J., Tavakoli, N. P., Idrissova, Z., Viglietta, V., Rostasy, K., Pohl, D., ... Wucherpfennig, K. W. (2007). Self-antigen tetramers discriminate between myelin autoantibodies to native or denatured protein. Nature Medicine, 13(2), 211–217. https://doi.org/10.1038/nm1488
Ramanathan, S., Dale, R. C., & Brilot, F. (2016). Anti-MOG antibody: The history, clinical phenotype, and pathogenicity of a serum biomarker for demyelination. Autoimmunity Reviews, 15(4), 307–324. https://doi.org/10.1016/j.autrev.2015.12.004
Ramanathan, S., Mohammad, S., Tantsis, E., Nguyen, T. K., Merheb, V., Fung, V. S. C., White, O. B., Broadley, S., Lechner-Scott, J., Vucic, S., Henderson, A. P. D., Barnett, M. H., Reddel, S. W., Brilot, F., & Dale, R. C. (2018). Clinical course, therapeutic responses and outcomes in relapsing MOG antibody-associated demyelination. Journal of Neurology, Neurosurgery & Psychiatry, 89(2), 127–137. https://doi.org/10.1136/jnnp-2017-316880
Reindl, M., & Waters, P. (2019). Myelin oligodendrocyte glycoprotein antibodies in neurological disease. Nature Reviews Neurology, 15(2), 89–102. https://doi.org/10.1038/s41582-018-0112-x
Rempe, T., Tarhan, B., Rodriguez, E., Viswanathan, V. T., Gyang, T. V., Carlson, A., Tuna, I. S., & Rees, J. (2021). Anti-MOG associated disorder–clinical and radiological characteristics compared to AQP4-IgG+ NMOSD–a single-center experience. Multiple Sclerosis and Related Disorders, 48, 102718. https://doi.org/10.1016/j.msard.2020.102718
Schwake, C., Ladopoulos, T., Häußler, V., Kleiter, I., Ringelstein, M., Aktas, O., Kümpfel, T., Engels, D., Havla, J., Hümmert, M. W., Kretschmer, J. R., Tkachenko, D., Trebst, C., Ayroza Galvão Ribeiro Gomes, A. B., Pröbstel, A.-K., Korporal-Kuhnke, M., Wildemann, B., Jarius, S., Pul, R., ... Ayzenberg, I. (2025). Apheresis therapies in MOGAD: A retrospective study of 117 therapeutic interventions in 571 attacks. Journal of Neurology, Neurosurgery & Psychiatry, 96(7), 639–646. https://doi.org/10.1136/jnnp-2024-334863
Sechi, E., Cacciaguerra, L., Chen, J. J., Mariotto, S., Fadda, G., Dinoto, A., Lopez-Chiriboga, A. S., Pittock, S. J., & Flanagan, E. P. (2022). Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): A review of clinical and MRI features, diagnosis, and management. Frontiers in Neurology, 13, 885218. https://doi.org/10.3389/fneur.2022.885218
Spatola, M., Chuquisana, O., Jung, W., Lopez, J. A., Wendel, E.-M., Ramanathan, S., Keller, C. W., Hahn, T., Meinl, E., Reindl, M., Dale, R. C., Wiendl, H., Lauffenburger, D. A., Rostásy, K., Brilot, F., Alter, G., & Lünemann, J. D. (2023). Humoral signatures of MOG-antibody-associated disease track with age and disease activity. Cell Reports Medicine, 4(2), 100913. https://doi.org/10.1016/j.xcrm.2022.100913
Takai, Y., Misu, T., Kaneko, K., Chihara, N., Narikawa, K., Tsuchida, S., Nishida, H., Komori, T., Seki, M., Komatsu, T., Nakamagoe, K., Ikeda, T., Yoshida, M., Takahashi, T., Ono, H., Nishiyama, S., Kuroda, H., Nakashima, I., Suzuki, H., ... Fujimori, J. (2020). Myelin oligodendrocyte glycoprotein antibody-associated disease: An immunopathological study. Brain, 143(5), 1431–1446. https://doi.org/10.1093/brain/awaa102
Trewin, B. P., Brilot, F., Reddel, S. W., Dale, R. C., & Ramanathan, S. (2025). MOGAD: A comprehensive review of clinicoradiological features, therapy and outcomes in 4699 patients globally. Autoimmunity Reviews, 24(1), 103693. https://doi.org/10.1016/j.autrev.2024.103693
Trewin, B. P., Dale, R. C., Qiu, J., Chu, M., Jeyakumar, N., Dela Cruz, F., Andersen, J., Siriratnam, P., Ma, K. K. M., Hardy, T. A., Van Der Walt, A., Lechner-Scott, J., Butzkueven, H., Broadley, S. A., Barnett, M. H., Reddel, S. W., Brilot, F., Kalincik, T., & Ramanathan, S. (2024). Oral corticosteroid dosage and taper duration at onset in myelin oligodendrocyte glycoprotein antibody-associated disease influences time to first relapse. Journal of Neurology, Neurosurgery & Psychiatry, 95(11), 1054–1063. https://doi.org/10.1136/jnnp-2024-333463
Uzawa, A., Oertel, F. C., Mori, M., Paul, F., & Kuwabara, S. (2024). NMOSD and MOGAD: An evolving disease spectrum. Nature Reviews Neurology, 20(10), 602–619. https://doi.org/10.1038/s41582-024-01014-1
Wang, X., Kong, L., Zhao, Z., Shi, Z., Chen, H., Lang, Y., Lin, X., Du, Q., & Zhou, H. (2022). Effectiveness and tolerability of different therapies in preventive treatment of MOG-IgG-associated disorder: A network meta-analysis. Frontiers in Immunology, 13, 953993. https://doi.org/10.3389/fimmu.2022.953993
Waters, P., Fadda, G., Woodhall, M., O’Mahony, J., Brown, R. A., Castro, D. A., Longoni, G., Irani, S. R., Sun, B., Yeh, E. A., Marrie, R. A., Arnold, D. L., Banwell, B., Bar-Or, A., & Canadian Pediatric Demyelinating Disease Network. (2020). Serial anti–myelin oligodendrocyte glycoprotein antibody analyses and outcomes in children with demyelinating syndromes. JAMA Neurology, 77(1), 82–93. https://doi.org/10.1001/jamaneurol.2019.2940
Wegener-Panzer, A., Cleaveland, R., Wendel, E.-M., Baumann, M., Bertolini, A., Häusler, M., Knierim, E., Reiter-Fink, E., Breu, M., Sönmez, Ö., Della Marina, A., Peters, R., Lechner, C., Piepkorn, M., Roll, C., Höftberger, R., Leypoldt, F., Reindl, M., & Rostásy, K. (2020). Clinical and imaging features of children with autoimmune encephalitis and MOG antibodies. Neurology: Neuroimmunology & Neuroinflammation, 7(4), e731. https://doi.org/10.1212/NXI.0000000000000731
Wingerchuk, D. M., Banwell, B., Bennett, J. L., Cabre, P., Carroll, W., Chitnis, T., De Seze, J., Fujihara, K., Greenberg, B., Jacob, A., Jarius, S., Lana-Peixoto, M., Levy, M., Simon, J. H., Tenembaum, S., Traboulsee, A. L., Waters, P., Wellik, K. E., & Weinshenker, B. G. (2015). International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology, 85(2), 177–189. https://doi.org/10.1212/WNL.0000000000001729
Wolf, A. B., Palace, J., & Bennett, J. L. (2023). Emerging principles for treating myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Current Treatment Options in Neurology, 25(11), 437–453. https://doi.org/10.1007/s11940-023-00776-1
Wong, Y. Y. M., Hacohen, Y., Armangue, T., Wassmer, E., Verhelst, H., Hemingway, C., Van Pelt, E. D., Catsman‐Berrevoets, C. E., Hintzen, R. Q., Deiva, K., Lim, M. J., Rostásy, K., & Neuteboom, R. F. (2018). Paediatric acute disseminated encephalomyelitis followed by optic neuritis: Disease course, treatment response and outcome. European Journal of Neurology, 25(5), 782–786. https://doi.org/10.1111/ene.13602
Wynford-Thomas, R., Jacob, A., & Tomassini, V. (2019). Neurological update: MOG antibody disease. Journal of Neurology, 266(5), 1280–1286. https://doi.org/10.1007/s00415-018-9122-2
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Katarzyna Żurek, Patrycja Rędziniak, Monika Rajs, Patrycja Przebieradło, Sandra Żak, Alicja Ruzik, Antonina Gaj-Hunter, Monika Kowalska, Kaja Stolarska, Sandra Terpiłowska, Małgorzata Żurek, Piotr Wojciechowski
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
How to Cite
