Abstract Details

Title Frequency of the Supporting Features for MOGAD Diagnosis in Patients with Multiple Sclerosis

Topic Autoimmune Neurology

Presentation(s) P11 - Poster Session 11 (8:00 AM-9:00 AM)

Poster/Presentation
Number 8-019

Objective To assess the frequency of the supporting features for myelin oligodendrocyte
glycoprotein antibody-associated disease (MOGAD) diagnosis in patients with multiple
sclerosis/clinically isolated syndrome (MS/CIS).

Background Supporting clinical/MRI features are required to diagnose MOGAD in patients at
high risk of false MOG-IgG positivity (low/unavailable titer, CSF-restricted), to help differentiation
from mimics, primarily MS. The proportion of MS/CIS patients showing MOGAD supporting
features is unknown.

Design/Methods We retrospectively identified patients diagnosed at the University Hospital of Sassari
(January 2021-September 2024) with: 1) Relapsing-remitting MS/CIS (2017 McDonald criteria);
and 2) brain/spinal cord MRI obtained ≤6 weeks of the presenting attack. Patients with MOGAD
(n=6) or other relapsing demyelinating CNS disorders (isolated optic neuritis/myelitis, n=8;
aquaporin-4-IgG+NMOSD, n=5; other, n=3) were excluded. The frequency of the MOGAD
supporting features was assessed in the symptomatic CNS region (optic nerve, brain/brainstem
and/or spinal cord), and compared with alternative features typical of MOGAD.

Results A total of 110 patients with MS/CIS were included. Median age was 35 (range, 6-78)
years; 12(11%) were children. The symptomatic CNS regions were: brain/brainstem (n=45), spinal
cord (n=37), and optic nerves (n=31). MOGAD supporting features (≥1) were less common in
patients with MS/CIS (24/110[25%]) than other excluded relapsing demyelinating CNS disorders
(11/16[69%]); p<0.001. In patients with MS/CIS, the most represented supporting features were:
centrally located spinal T2-lesions (11/21[52%]); longitudinally extensive optic nerve abnormalities
(3/29[10%]), conus involvement (3/34[9%]), and deep grey nuclei involvement (4 /45[9%]).
Bilateral/simultaneous optic neuritis and diffuse cortical involvement were the least common (0%).
Alternative typical MOGAD features not observed in MS/CIS were: presence of encephalopathy,
CSF pleocytosis >50 cells, and complete resolution of MRI abnormalities.

Conclusions MOGAD supporting features are not uncommon in patients with MS/CIS, with a
variable feature-specific frequency (0-52%). Awareness of this variability may help reduce
misdiagnoses and inform future refinements of the MOGAD diagnostic criteria.

Authors/Disclosures
Pietro Zara, MD (University of Sassari) PRESENTER	Dr. Zara has nothing to disclose.
Stefania Leoni, Sr., MD, PhD	Dr. Leoni has nothing to disclose.
Sara Etzi	Dr. Etzi has nothing to disclose.
Sabrine Othmani, MD	Dr. Othmani has nothing to disclose.
Valentina Floris, MD	Dr. Floris has nothing to disclose.
maria margherita sechi, MD	Dr. sechi has nothing to disclose.
Rosa Cortese (University of Siena)	No disclosure on file
Matteo Gastaldi, MD, PhD (IRCCS Mondino Foundation)	Dr. Gastaldi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for alexion, Roche, UCB, J&J. The institution of Dr. Gastaldi has received research support from Italian Ministry of Health, FISM, AE alliance.
Sara Mariotto, MD, PhD (Neurology Unit, University of Verona)	Dr. Mariotto has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Biogen, Sanofi, Alexion, Roche, TSF, Dynamics, UCB, Novartis, Amgen, AAN. The institution of Dr. Mariotto has received research support from Ministero della Salute Italiano. The institution of Dr. Mariotto has received research support from TSF. The institution of Dr. Mariotto has received research support from GJF. The institution of Dr. Mariotto has received research support from Lundbeck. The institution of Dr. Mariotto has received research support from Euroimmun. The institution of Dr. Mariotto has received research support from FISM.
Stefano Sotgiu	Stefano Sotgiu has nothing to disclose.
Paolo Solla, MD (Ospedale Binaghi)	Dr. Solla has nothing to disclose.
Elia Sechi, MD (University of Sassari)	Dr. Sechi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Sechi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Argenx.

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