Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently defined demyelinating disorder of the central nervous system, with a rapidly evolving clinical spectrum. Myelin oligodendrocyte glycoprotein (MOG) is a protein found on the surface of myelin-forming oligodendrocytes. The optimization of MOG antibody testing is a relatively recent development in the field of neuroimmunology, which helped define the MOGAD spectrum. (Kitley et al., 2014; Mader et al., 2011) Since then, the utilization of cell-based assays for detection of serum MOG antibodies has increased in clinical practice, helping in further characterization of single or recurrent demyelinating attacks. However, the widespread use of MOG antibody testing has increased the likelihood of false positive results, necessitating caution in interpreting the findings.

MOGAD can manifest with a variety of clinical presentations, including optic neuritis (ON), transverse myelitis (TM), acute disseminated encephalomyelitis (ADEM), brainstem syndromes, and cortical encephalitis. ON is the most common clinical presentation especially among adults. (Waters et al., 2020; Marignier et al., 2021) Whilst, ADEM is the most common presentation among the pediatric population. (Jarius et al., 2016; Juryńczyk et al., 2019)

The diagnosis of MOGAD has relied primarily on clinical judgment supported by serology testing of MOG antibodies. Since it is a demyelinating disease, there is a significant overlap with neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS), in both the clinical presentation and neuroradiology findings. This highlights the importance of developing diagnostic criteria for MOGAD to distinguish it from other similar conditions. Proposed new criteria for MOGAD have been recently developed to refine the diagnostic spectrum of the disease and improve diagnostic accuracy. (Banwell et al., 2023) At the time of this writing, the new proposed criteria have not been used or tested in real life clinical practice to the best of our knowledge. The aim of this timely study is to apply the new criteria to a real-life cohort of MOGAD patients and compare the performance of the criteria to clinical judgment of the treating neuroimmunologists.