This cross-sectional study at UTHealth Houston examined (1) predictors of higher disability (EDSS ≥3 at diagnosis); (2) prevalence and correlates of psychiatric symptoms; (3) clinical/MRI differences between NMOSD and MOGAD; and (4) disparities in Disease-Modifying Therapy (DMT) initiation.

Neuromyelitis Optica Spectrum Disorder (NMOSD) and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) are severe autoimmune disorders of the central nervous system with significant disability and symptom burden. Understanding clinical, sociodemographic, and treatment factors is essential to optimize care.

NMOSD patients were older, more often female, and more frequently Black/African American compared with MOGAD, with higher EDSS and greater prevalence of neuropathic pain, weakness, and spinal cord lesions (all p<0.05). Higher disability was associated with NMOSD (p=0.004), older age (p=0.015), neuropathic pain (p=0.013), and weakness (p=0.018). Psychiatric symptoms were common (53%) but did not differ by diagnosis (p=0.5); they were associated with female sex (p=0.016) and obesity (p=0.002). Black/African American (OR=4.32, p=0.003) and “Other” racial groups (OR=14.2, p=0.045) had higher odds of delayed DMT initiation (>2 months) compared to White patients. EDSS change at one year did not differ by early vs. delayed initiation (p=0.14).

NMOSD and MOGAD show distinct clinical profiles, with psychiatric symptoms affecting over half of patients. Female sex and obesity were linked to psychiatric burden, while racial disparities in DMT initiation highlight urgent equity gaps. Early intervention and integrated mental health care are critical to improving outcomes.