Assessing the applicability of the 2023 international MOGAD panel criteria in real-world clinical settings

Abstract

Introduction: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently identified demyelinating disorder with a diverse clinical spectrum. Diagnosing MOGAD traditionally relies on clinical judgment, highlighting the necessity for precise diagnostic criteria. Banwell et al. proposed criteria, aiming to refine the diagnostic spectrum. This study evaluates these criteria in a real-life cohort, comparing their performance with clinical judgment and describe the cohort of MOGAD patients.

Methods: This retrospective study, conducted at Hadassah Medical Center, included 88 patients with MOG-IgG antibodies. Patients with a positive or borderline MOG-IgG antibodies by cell-based assay were included. Demographics, clinical and MRI data were recorded. Cases were divided into definite MOGAD and Non-MOGAD groups as determined by the treating physician. We assessed the sensitivity and specificity of the new criteria in comparison to treating physicians' evaluations. Additionally, we examined clinical differences between the MOGAD and Non-MOGAD groups.

Results: We observed a strong concordance (98%) between the new MOGAD criteria and treating physicians' diagnoses. Clinical disparities between MOGAD and Non-MOGAD groups included lower EDSS scores, normal MRI scans, preserved brain volume, negative OCB results, and distinct relapse patterns. Also, compared to relapsing patients, monophasic MOGAD patients have greater brain volume and a lower age at onset.

Conclusion: The study demonstrates robust accuracy of new MOGAD criteria, emphasizing their potential to enhance diagnostic precision. Treatment response integration into the MOGAD diagnosis is crucial, as it could aid in distinguishing MOGAD from other demyelinating disorders. Distinct clinical profiles highlight the importance of informed decisions in managing MOGAD and similar disorders.

Keywords: Diagnosis; MOG-IgG; MOGAD; Volumetry.

Fig. 1

Correlations between brain volume and clinical data of anti-MOG positive patients. a There is a significant correlation between normalized brain volume and EDSS (r = -0.46, p = 0.01). b Normalized brain volume was significantly higher in patients with a monophasic course compared to those with a relapsing course (64.48 ± 35.10 vs 22.24 ± 30.18, p = 0.004). c Normalized brain volume was significantly higher in patients with normal brain MRI scans versus those with abnormal scans (54.74 ± 39.50 vs 26.73 ± 31.14, p = 0.03).

Fig. 2

Flowchart comparison of physician diagnoses and new criteria for MOGAD determination