MOG antibody-related diseases (MOGAD) and AQP4 antibody-related diseases are immunologically distinct pathologies. Our aim was to compare the clinical and radiological features of MOG antibody-related diseases with AQP4 antibody-related diseases and seronegative demyelinating diseases.

There were a total of 103 patients – 41 patients of MOGAD, 37 patients of AQP4 antibody-related diseases and 25 seronegative demyelinating disease. Bilateral optic neuritis was the most frequent phenotype in patients with MOGAD (18/41) whereas myelitis was the most common phenotype in the AQP4 (30/37) and seronegative groups (13/25). Cortical, juxtacortical lesions, anterior segment optic neuritis, optic sheath enhancement, and conus involvement in myelitis were radiological findings that separated MOGAD from AQP4 related diseases. Nadir EDSS and visual acuity were similar across the groups. Last follow up EDSS was significantly better in the MOG antibody group as compared to AQP4 antibody group (1 (0-8) vs 3.5(0-8); p= 0.03). ADEM, myelitis, and seizures were more common in the younger population (< 18 vs > 18 years) in MOGAD ( 9 vs 2, p = 0.001 ;9 vs 7, p = 0.03; 6 vs 0, p = 0.001).

We identified several clinical and radiological features that can help physicians to distinguish MOGAD from AQP4 antibody related diseases. Differentiation is important as treatment response might vary among both groups.