MOG Antibody Disease (MOGAD)

Myelin oligodendrocyte glycoprotein (MOG) antibody disease is a relatively rare autoimmune condition. It occurs when the immune system attacks myelin, the protective sheath that covers nerves. MOG antibody disease causes inflammation and can potentially damage the brain, spinal cord, and the optic nerves that connect the eyes to the brain.

There are two main types of MOG antibody disease:

• Monophasic MOG antibody disease only causes symptoms once.
• Relapsing MOG antibody disease can wax and wane, with symptoms resolving for a while and then returning.

Children are more likely than adults to develop MOG antibody disease.

The symptoms of MOG antibody disease depend on the location of nerve inflammation. Symptoms are typically divided into three groups:

Optic neuritis:

• Vision loss in one or both eyes
• Pain that gets worse when moving the eye(s)
• Decreased ability to see color

Transverse myelitis:

• Weakness in the arms or legs
• Numbness or tingling in the arms or legs
• Muscle stiffness
• Loss of bowel or bladder control
• Paralysis

Acute disseminated encephalomyelitis (ADEM):

• Fever
• Headache
• Confusion
• Nausea or vomiting
• Fatigue
• Weakness in the arms or legs
• Seizures

Children are more likely to experience ADEM and optic neuritis than adults. The above syndromes can overlap as well.

As with many autoimmune diseases, the cause of MOG antibody disease is still unclear. It is likely that several factors come together in a person before MOG antibodies form and subsequently cause symptoms.

Your child’s doctor will perform a physical exam and ask about their medical history and symptoms. They will also recommend other tests to help diagnose MOG antibody disease, such as:

• Blood tests
• Eye exam
• MRI scan
• Lumbar puncture (spinal tap)

These tests can help identify signs of MOG antibody disease and rule out multiple sclerosis, and other conditions, which can have similar symptoms.

Treatment for MOG antibody disease is aimed at stopping symptoms, speeding recovery, and preventing future relapses. Depending on your child’s individual case, treatment options may include:

• Corticosteroids. Steroid medications help relieve inflammation and address related symptoms. They are typically given intravenously at high doses for a set number of days, then tapering off to a lower dose over several weeks. Your child’s doctor may also recommend a course of oral steroid medication for a longer period of time.
• Intravenous immunoglobulin (IVIG). This infusion treatment transfers antibodies from healthy donors to children who need them, including those with MOG antibody disease. IVIG helps reduce inflammation and calm the immune system, without reducing the ability to fight off infections, to help prevent relapses.
• Plasmapheresis (plasma exchange). Plasmapheresis is a procedure that removes the part of your child’s blood called plasma and separates it from the red blood cells. Through this process, MOG antibodies are removed from the blood plasma. The red blood cells are then mixed with a plasma substitute and returned to your child’s body. It may be an option for children who have severe symptoms or haven’t responded enough to steroids.
• Other treatments. Your child’s doctor may prescribe other medications, such as headache or anti-seizure drugs, to treat certain symptoms of MOG antibody disease. They may also recommend immunosuppressants or other drugs to prevent relapses.

At Boston Children’s Hospital, we care for children with MOG antibody disease in our Neuroimmunology Center. Our team of pediatric neuroimmunologists takes a multidisciplinary approach, working with other specialists throughout Boston Children’s who have expertise in caring for children with MOG antibody disease, including immunologists, infectious disease experts, ophthalmologists, psychologists, physical therapists, education specialists, and others. Together, we will create a treatment plan that puts your family in the center and aims to get your child back to optimal function and health as soon as possible.