This hypothesis was later supported by their discovery in the sera and cerebrospinal fluid (CSF) of patients with multiple sclerosis (MS), using techniques such as enzyme-linked immunosorbent assay and Western blot. MOG antibodies have been extensively studied over the last 30 years, with some early experimental studies hypothesising a pathogenic role in CNS inflammatory diseases. Although its exact role remains unclear, it is thought to act as a cellular adhesive molecule, to be involved as a regulator of oligodendrocyte microtubule stability and to mediate complement cascade. Myelin oligodendrocyte glycoprotein (MOG) is a glycoprotein located on the myelin surface and found exclusively in the central nervous system (CNS). Randomised control trials are limited, but observational open-label experience suggests a role for high-dose steroids and plasma exchange in the treatment of acute attacks, and for immunosuppressive therapies, such as steroids, oral immunosuppressants and rituximab as maintenance treatment. Cerebrospinal fluid oligoclonal bands are uncommon. MRI characteristics can help in differentiating MOG-AD from other neuroinflammatory disorders, including multiple sclerosis and neuromyelitis optica. To avoid misdiagnosis, MOG antibody testing should be undertaken in selected cases presenting clinical and paraclinical features that are felt to be in keeping with MOG-AD, using a validated cell-based assay. Recent advances in MOG antibody testing offer improved sensitivity and specificity. Residual disability develops in 50–80% of patients, with transverse myelitis at onset being the most significant predictor of long-term outcome. Disease course can be either monophasic or relapsing, with subsequent relapses most commonly involving the optic nerve. Although no age group is exempt, median age of onset is within the fourth decade of life, with optic neuritis being the most frequent presenting phenotype. Myelin oligodendrocyte glycoprotein (MOG) antibody disease (MOG-AD) is now recognised as a nosological entity with specific clinical and paraclinical features to aid early diagnosis.
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