In some people, it can be very challenging for the medical team to distinguish between the two disorders and depending on the clinical presentation, it is likely that both antibodies, for NMOSD aquaporin – antibodies (AQP4 and MOG) will be sent for testing in the blood simultaneously. Brain lesions in MOGAD are present in only a third of patients, and are often described as being much bigger than the usual lesions seen in MS. Brain involvement in the two disorders may also differ. In the spinal cord, involvement of the lower part of the spinal cord that controls bladder and bowel function is more prominent in MOGAD than NMOSD. Radiological features may also be of assistance in differentiating between the two disorders, with different features on MRI around the optic nerves and the positioning of damage on the visual pathway. Additionally, seizures are more commonly seen in MOGAD (mainly with ADEM in children) but are very rare in NMOSD. MOGAD patients with optic neuritis may present with swollen optic discs more commonly, which can be visible by bedside examination with a special light instrument – this is less common in NMOSD. However, there are additional clinical and radiological features (MRIs of the brain, optic nerves, and spinal cord), and therapeutic responses which help to differentiate between NMOSD and MOGAD. Both disorders may present rather quickly with significant disability. This is quite different to the symptoms of MOGAD described above and can cause decreased levels of consciousness, headache, seizures, behavioural changes, and may occur in isolation or together with optic neuritis and/or transverse myelitis.īoth MOGAD and NMOSD may present with involvement of long segments of the optic nerves (longitudinally extensive optic neuritis) and spinal cord (usually three or more vertebral segments, referred to as longitudinally extensive transverse myelitis). One of the most common presentations of MOGAD in children below the age of ten is acute disseminated encephalomyelitis (ADEM), where children present with inflammation of the brain (encephalitis). Transverse myelitis may present with weakness or sensory changes of the limbs, and problems with bladder, bowel, and/or sexual function. Some people with MOGAD may present with transverse myelitis (inflammation of the spinal cord), either by itself or in combination with optic neuritis, although this is less common. Optic neuritis can also be painful, especially with eye movement, as the optic nerve is inflamed and swollen. This includes blurred vision, problems seeing colours, and partial loss of vision. Optic neuritis causes visual disturbances as messages passing between the eye and the brain are disrupted due to the damaged myelin. Most cases of MOGAD appear with optic neuritis (inflammation of the optic nerve behind the eye) in one (unilateral optic neuritis) or often both eyes (bilateral optic neuritis). We now know that MOGAD is a distinct disorder, separate from both NMOSD and MS, with different underlying processes occurring in the brain, optic nerve and spinal tissues, and unique clinical and radiological features, treatment approaches, and prognosis. This happens less frequently now with the availability of specific diagnostic blood tests for the detection of these important MOG antibodies, and recognition of the clinical and radiological features (MRIs of the brain, optic nerves, and spinal cord) which distinguish these three disorders. As there is some overlap in signs and symptoms of MOGAD, NMOSD and MS, it has sometimes been difficult to separate the three different diseases, and every so often NMOSD and MOGAD were previously diagnosed as being a form of MS. In MOGAD, the immune system mistakenly makes antibodies targeting MOG, which results in demyelination. Myelin oligodendrocyte glycoprotein (MOG) is a protein which is present on the outermost layer of special cells called oligodendrocytes in the CNS, which produce the protective myelin sheath around nerve cells. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an inflammatory demyelinating disorder of the central nervous system (CNS). The International MS Genetics Consortium.Vitamin D MS Prevention Trial – PrevANZ.
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