An autoimmune disorder that negatively affects the protective cover of the nerves (myelin) is called myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). When it occurs, the immune system mistakenly attacks healthy tissue in the body instead of viruses, bacteria, and other germs that can make you ill. MOGAD also affects multiple organs in the body, including the eyes, brain, spinal cord, and others. That’s why people with this disorder may experience different symptoms (such as loss of vision, confusion, muscle weakness, and others).
In normal circumstances, the immune system fights against bacteria, parasites, viruses, and other germs that cause illnesses. However, in people with MOGAD, the antibodies produced by the immune system do not get the correct instructions. As a result, these antibodies begin to attack healthy cells in the body, causing inflammation. Furthermore, the process in which the myelin (the protective cover of the nerves) is attacked is known as demyelination.
Usually, it is difficult to diagnose MOGAD because the most common symptoms of this autoimmune disorder resemble other health conditions, such as optic neuritis, transverse myelitis, and acute disseminated encephalomyelitis (ADEM). In addition, MOGAD is a rare demyelinating disorder that affects about 1 to 3 people per million each year.
Types of MOGAD
Healthcare professionals have divided this autoimmune condition into 2 primary types. For example:
- Monophasic MOGAD – This type occurs when the affected person experiences an attack of symptoms once only.
- Relapsing MOGAD – In such cases, the symptoms disappear for a short time (remission) and then return (relapse).
Symptoms
Mostly, the symptoms appear differently among people who develop this condition because it depends on which part of the body is affected. Check some eye symptoms below:
- Eye pain
- Blindness (vision loss)
- Double or blurred vision
Spinal Cord Symptoms
These include:
- Spasticity (muscle stiffness)
- Problems with emptying the bladder
- Numbness
- Muscle weakness
- Bladder or bowel control problems
- A sharp or shooting pain or a tingling sensation in the neck, back, or abdominal area
Brain Symptoms
For example:
- Behavioral changes
- Seizures
- Loss of consciousness
- Confusion
- Headaches
- Problems with balance and coordination
Do not hesitate to see a doctor if you or your child has any of the previous symptoms. Otherwise, it may lead to serious complications.
Causes and Risk Factors
Experts do not fully understand what exactly causes this autoimmune disorder. It is not inherited and does not have a genetic cause. However, physicians have identified some factors that may increase your risk of developing MOGAD. These include:
- Age – While it may occur at any age, it mostly affects children and young adults. Most of the time, ADEM occurs in children under 5 years old, but older children or adults mostly develop optic neuritis or transverse myelitis.
- Recent or frequent viral infections (such as COVID-19, Epstein-Barr, SARS-CoV-2, and others)
- Other autoimmune disorders
- Suddenly stopping high-dose steroids
What Are The Potential Complications of MOGAD?
Without early diagnosis and proper treatment, this disorder may cause permanent complications. Check some examples below:
- Loss of vision – This complication is often caused by a severe optic neuritis that may also cause blurred vision, loss of color vision, or even permanent blindness (vision loss) in one or both eyes.
- Physical disability – These include permanent muscle weakness, stiffness, and paralysis in the arms and legs. They are caused by transverse myelitis (also known as spinal cord inflammation).
- Neurological dysfunction – When this complication occurs, it often leads to seizures, chronic (long-lasting) fatigue, headaches, and cognitive impairment (including memory loss and problems with language and thinking).
- Autonomic problems – These include chronic bladder, bowel, or sexual dysfunction.
- Relapses – This complication may cause more damage to certain parts of the body and increased disability.
- Severe brain dysfunction due to ADEM
- Sensory and mobility problems – For example, numbness, tingling, pain, tremors, dizziness, or imbalance.
- Chronic pain
- Mental disorders (such as depression)
This article does not contain a complete list of MOGAD complications. In any case, you can talk with your doctor about measures to reduce the risk or prevent them. Additionally, there is no way to prevent or reduce the risk of MOGAD because physicians do not know the exact cause. Sometimes, physicians may recommend clinical trials, which involve studies or tests on people.
Diagnosis
When doctors suspect MOGAD, the diagnosis begins with a physical and neurological examination to check for irregularities linked to the disease. After that, they may also ask some questions about your medical history and symptoms to get more clues about your condition. In any case, to confirm or rule out MOGAD, doctors will perform the following tests and procedures. For example:
- Lumbar puncture (also known as a spinal tap)
- Eye examination
- Blood tests
- MRI (magnetic resonance imaging) scans
MOGAD Markers
These include:
- Brain or spinal cord lesions
- Oligoclonal bands (groupings of antibodies) that are often missing in people with MOGAD, but present in other disorders
- Increased white blood cell count
Treatment
Unfortunately, at this moment, there is no way to cure this autoimmune disorder. That’s why the treatment goal is to reduce the symptoms, prevent life-threatening complications, and improve your quality of life. Check below some treatments often recommended by physicians for people with MOGAD:
- Steroids – Physicians often recommend intravenous (IV) Methylprednisolone for about 3-5 days. It helps reduce inflammation and damage to the affected organs.
- Plasma exchange – This procedure involves a machine that removes the plasma from the blood and replaces it. Thereafter, it is returned into your body.
- Intravenous immunoglobulin (IVIG) – During this treatment, a doctor will replace antibodies in the blood with donor antibodies intravenously.
- Immunosuppressants – This group of medicines is used to suppress the immune system that attacks healthy tissue and causes symptoms.
Furthermore, people who are at risk of relapses may need long-term treatment that usually includes the following options. For example, Mycophenolate mofetil, Rituximab, Azathioprine, IVIG infusions or subcutaneous immunoglobulin injections, and immunosuppressants.
Frequently Asked Questions
What is the life expectancy for MOGAD?
While the condition does not affect your life expectancy, the complications it causes may significantly reduce your lifespan. Get medical care as soon as possible if any of them occur.
When does a MOGAD diagnosis happen?
Most of the time, people get a diagnosis of MOGAD in their 20s or 30s, but this autoimmune disorder may affect anyone. When it affects children, they get the diagnosis before the age of 11.
Are MOGAD symptoms different in adults and children?
The symptoms are often different among people, and some of them depend on the age of the affected person. For instance, in people, this autoimmune disorder targets the brain, but in adults, it often affects the eyes and spinal cord.
What are MOGAD symptoms?
Commonly, people who develop MOGAD experience the following symptoms. For example:
- Bowel or bladder issues
- Paralysis or weakness in the arms or legs
- Confusion
- Drowsiness
- Coma
- Pain affects the eyes, back, legs, arms, or chest area
- Loss of color vision
- Vision problems (such as blurred vision, double vision, and others)
What is the difference between MOGAD and MS?
While both conditions are autoimmune disorders, there are some differences in their targets, lesion patterns, and treatment responses. For instance, MOGAD mostly causes bilateral optic neuritis and specific spinal cord lesions, but multiple sclerosis (MS) often causes multiple brain and spine lesions. If you have any other questions, ask your healthcare provider.
