MOGAD Awareness Month: From Emerging Entity to Evolving Clinical Priority

MOGAD Awareness Month, held annually in April, draws attention to myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD), the relatively recent recognition of the condition and the rapid pace at which understanding of the disease continues to evolve. Started by the Siegel Rare Neuroimmune Association (SRNA) in conjunction with the MOG Project, the awareness month was first acknowledged in 2022 and aims to spotlight the needs of this growing patient population.

A Brief History of Recognition

For years, patients now understood to have MOGAD were often classified under broader demyelinating conditions such as multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD). It was not until advances in antibody testing—particularly the development of cell-based assays (CBAs) targeting myelin oligodendrocyte glycoprotein—that MOGAD began to emerge as a distinct clinical entity in the early 21st century.^1,2

These assays enabled clinicians and researchers to more accurately identify patients with MOG-specific antibodies, separating them from those with aquaporin-4 antibody–positive disease. This distinction proved critical, as clinical course, prognosis, and treatment response differ meaningfully across these disorders.² The establishment of MOGAD as its own diagnostic category has since reshaped the framework of inflammatory demyelinating diseases, emphasizing the role of antibody-mediated pathology in central nervous system disorders.¹

The Role of Technology in Diagnosis and Research

Technological advances remain central to both the recognition and ongoing study of MOGAD. Among these, MRI continues to play a foundational role in clinical care, with ongoing research exploring more advanced imaging approaches.³

“Primarily, I think this is MRI scans; research is utilizing some advanced/quantitative MRI, but that is not being done clinically yet,” explained Erin Longbrake, MD, PhD, associate professor of neurology at the Yale School of Medicine. “Additionally, the development of cell-based assays were critical to MOGAD being recognized as a disease, and appropriate use of CBA is still integral to correctly diagnosing MOGAD.”

While quantitative MRI techniques may eventually enhance disease characterization, their integration into routine practice remains limited. In contrast, CBAs are now considered essential for accurate diagnosis, though variability in access and interpretation continues to present challenges in some settings.²

Shifting Research Priorities

As the field matures, research efforts are increasingly focused on understanding the underlying immunobiology of MOGAD and refining prognostic tools.¹

“Areas of particular interest are in understanding the immunobiology of MOGAD—how the immune system mediates damage—and understanding how to predict at the time of diagnosis whether a patient may have a monophasic or a relapsing course,” Longbrake told NeurologyLive. “This matters in terms of deciding whether to put someone on long-lasting immune medications up front or not.”

This distinction between monophasic and relapsing disease remains one of the most clinically relevant unanswered questions. While some patients experience a single inflammatory episode with good recovery, others develop recurrent attacks that can lead to cumulative disability. Identifying reliable predictors of disease course could significantly influence early treatment decisions and long-term management strategies.

Implications for Clinical Practice

Despite growing awareness, MOGAD remains underrecognized in some clinical contexts, particularly outside of specialty centers. Experts emphasize that improving outcomes begins with maintaining a high index of suspicion and ensuring appropriate testing.

“Mainly by maintaining awareness of the disease and testing for it appropriately,” Longbrake said when asked how clinicians can optimize treatment.

Accurate diagnosis is especially important given that therapies commonly used for multiple sclerosis may not be effective in MOGAD and, in some cases, could worsen outcomes. Current management strategies rely largely on off-label approaches, including corticosteroids for acute attacks and immunosuppressive therapies such as intravenous immunoglobulin, rituximab, or mycophenolate mofetil for relapse prevention.

Looking Ahead

MOGAD Awareness Month serves as a reminder of both progress and persistent gaps. The field has moved from diagnostic ambiguity to clearer disease definition within a relatively short period, driven largely by advances in antibody testing and neuroimaging.

However, significant unmet needs remain, including the development of standardized diagnostic protocols, validated biomarkers for disease course prediction, and evidence-based treatment guidelines supported by randomized clinical trials.

As research continues to deepen understanding of MOGAD’s immunopathogenesis and clinical heterogeneity, increased awareness among clinicians will remain essential. Early recognition, appropriate use of diagnostic tools, and informed therapeutic decision-making are key to improving outcomes for patients affected by this complex and evolving neurologic disease.¹

REFERENCES
1. Jarius S, Paul F, Aktas O, et al. MOG encephalomyelitis: international recommendations on diagnosis and antibody testing. J Neuroinflammation. 2018;15(1):134. doi:10.1186/s12974-018-1144-2
2. Reindl M, Waters P. Myelin oligodendrocyte glycoprotein antibodies in neurological disease. Nat Rev Neurol. 2019;15(2):89-102. doi:10.1038/s41582-018-0112-x
3. Cobo-Calvo Á, Ruiz A, Maillart E, et al. Clinical spectrum and prognostic value of CNS MOG autoimmunity in adults. Neurology. 2018;90(21):e1858-e1869. doi:10.1212/WNL.0000000000005560