{ "abstract": "Background and objectives\n\nDistinguishing multiple sclerosis (MS) from myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can be challenging because of some shared clinical and radiologic features. We aimed to describe adults with clear positive serum MOG antibodies (MOG-Abs) presenting with MS features and rethink their nosological framework.Methods\n\nWe conducted a retrospective longitudinal study within the French NOMADMUS cohort and included adults from 2015 to 2025 tested clear positive for MOG-Ab in the serum with at least 1 MS-suggestive feature: (1) biological (CSF-specific oligoclonal bands [OCBs] and/or kappa free light chain index [KFLCi] ≥5.7) or (2) radiologic (≥1 lesion among juxtacortical lesion, Dawson finger, or inferior temporal lobe lesion). All MRI scans were reviewed blindly by an expert neuroradiologist. Minimum clinical and radiologic follow-up was 6 months. We classified patients as (1) typical MS when fulfilling 2024 McDonald criteria, with OCB and/or KFLCi ≥5.7 and showing no MOGAD supporting features, or (2) equivocal in all other situations.Results\n\nAmong the 78 included patients (65% female, median age: 35 years), 23% were classified as typical MS and 77% as equivocal; all met MOGAD criteria, and 76% met 2024 McDonald criteria, without using central veinous sign or paramagnetic rim lesion, which have been rarely assessed. Myelitis followed by optic neuritis constituted the predominant clinical presentations in the whole cohort (45% and 32%, respectively) and in both groups. For typical MS cases, half of the patients did not receive maintenance therapy after the first MOG-Ab-positive event, 28% relapsed, 55% developed new silent lesions, and none showed lesion resolution (median follow-up: 1.9 years). For equivocal patients, 84% had OCB and 88% had ≥1 MOGAD supporting feature. After the first MOG-Ab-positive event, 72% initiated a maintenance therapy-mostly rituximab-15% relapsed, 46% developed silent new lesions, and 23% showed complete resolution of ≥1 lesion (median follow-up: 3 years).Discussion\n\nClear positive MOG-Ab may occur in patients with genuine MS, and their presence may lead to therapeutic inertia. The substantial proportion of equivocal cases highlights current diagnostic limitations and underscores the need for longitudinal clinical and radiologic reassessment.", "abstract_shown": true, "affiliations": [ "Department of Neurology, centre de ressources et de compétences SEP-Paris, Pitié-Salpêtrière University Hospital, AP-HP, France.", "Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM)-Paris, France.", "Paris-Brain Institute (ICM), Paris Brain Institute's Data and Analysis Core, Pitié-Salpêtrière hospital, Sorbonne université, Inserm U1127, CNRS UMR 7225, France.", "Department of NeuroRadiology, Pitié-Salpêtrière University Hospital, AP-HP, Paris, France.", "Marseille University Hospital Timone, Neurology, France.", "Service de Neurologie, Sclerose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hospices Civils de Lyon, Bron, France.", "Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Service de neuro-inflammation, Hospices Civils de Lyon, France.", "Department of neurology, Rothschild Foundation Hospital, University Paris-Cité, Paris, France.", "Department of Neurology, CHU ROUEN, F-76000, Rouen, France.", "Department of neurology, Centre Hospitalier Princesse Grace, Monaco.", "University of Lille, Neurology, Inserm U 1172, CHU of Lille, France.", "Department of Neurology, University Hospital of Toulouse, CRC-SEP, France.", "University Toulouse III, Infinity, INSERM UMR1291-CNRS UMR5051, France.", "Montpellier University Hospital, Neurology, Montpellier, France.", "Department of Neurology, MS center, University Hospital of Bordeaux, France.", "Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Turc team, France.", "Department of Neurology, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, France.", "Department of Internal Medecine, 15-20 hospital, Paris, France.", "CRCSEP Neurologie Pasteur 2, CHU de Nice, Université Cote d'Azur, UMR2CA (URRIS), France.", "Department of neurology, Foch Hospital, Paris, France.", "Centre hospitalier universitaire de Nantes, Neurology Department, CR2TI-Inserm U1064, Nantes Université, CIC1413, France.", "IGF, Univ Montpellier, CNRS, INSERM, Service de Neurologie, CHU Nimes, France.", "Neurocentre Magendie, Bordeaux University, INSERM U1215, France.", "Université de Lyon, Université Claude Bernard Lyon 1, France.", "CHU Strasbourg, Neurology and CIC 1434, France.", "Neurology Department, Clinical Neuroscience Centre, CIC_P1414 INSERM, MOBIDIC _U1236, University Hospital, Rennes, France.", "Ophthalmology Department, Sorbonne Université, AP-HP, Pitie-Salpetriere University Hospital, Paris, France.", "Ophthalmology Department, Rothschild Foundation Hospital, University Paris-Cité, France; and.", "Immunology Department, Sorbonne Université, AP-HP, Pitie-Salpetriere University Hospital, Paris, France." ], "article_type": "research article", "arxiv": null, "author_total": 35, "authors": [ { "affs": [ 0, 1 ], "name": "Jeanne Garcia", "orcid": "0000-0003-2099-210X" }, { "affs": [ 2, 3 ], "name": "Natalia Shor", "orcid": "0000-0003-0693-1829" }, { "affs": [ 4 ], "name": "Clemence Boutiere", "orcid": "0009-0001-3119-8203" }, { "affs": [ 5, 6 ], "name": "Julie Pique", "orcid": "0000-0002-1986-7945" }, { "affs": [ 7 ], "name": "Marine Boudot De La Motte", "orcid": "0000-0002-6604-7923" }, { "affs": [ 8 ], "name": "Maxime Guillaume" }, { "affs": [ 9 ], "name": "Adrien Delourme" }, { "affs": [ 10 ], "name": "Helene Zephir", "orcid": "0000-0003-4029-2012" }, { "affs": [ 11, 12 ], "name": "Jonathan Ciron", "orcid": "0000-0002-3386-6308" }, { "affs": [ 13 ], "name": "Clarisse Carra-Dalliere", "orcid": "0000-0002-0985-3662" }, { "affs": [ 14 ], "name": "Pauline Buissonnière" }, { "affs": [ 15, 16 ], "name": "Nicolas Mélé", "orcid": "0000-0001-5390-401X" }, { "affs": [ 17 ], "name": "Jennifer Aboab", "orcid": "0000-0002-5022-4681" }, { "affs": [ 18 ], "name": "Mikael Cohen", "orcid": "0000-0002-3985-1297" }, { "affs": [ 19 ], "name": "Adrien Wang", "orcid": "0009-0004-6557-6956" }, { "affs": [ 20 ], "name": "Justine Couturier" }, { "affs": [ 3 ], "name": "Diana Rusu", "orcid": "0000-0002-0774-7655" }, { "affs": [ 21 ], "name": "Eric Thouvenot", "orcid": "0000-0001-8671-7747" }, { "affs": [ 20 ], "name": "David Axel Laplaud", "orcid": "0000-0001-6113-6938" }, { "affs": [ 14, 22 ], "name": "Aurélie Ruet", "orcid": "0000-0002-0020-8739" }, { "affs": [ 8 ], "name": "Bertrand Bourre", "orcid": "0000-0002-2459-2480" }, { "affs": [ 5, 6, 23 ], "name": "Françoise Durand-Dubief", "orcid": "0000-0002-2860-1700" }, { "affs": [ 5, 6 ], "name": "Lakhdar Benyahya", "orcid": "0009-0005-0046-9487" }, { "affs": [ 24 ], "name": "Nicolas Collongues", "orcid": "0000-0002-3683-5582" }, { "affs": [ 25 ], "name": "Laure Michel", "orcid": "0000-0002-8119-7794" }, { "affs": [ 7 ], "name": "Romain Deschamps", "orcid": "0000-0001-6291-8771" }, { "affs": [ 7 ], "name": "Caroline Papeix", "orcid": "0000-0003-4074-6125" }, { "affs": [ 4 ], "name": "Bertrand Audoin", "orcid": "0000-0002-9860-7657" }, { "affs": [ 0, 1, 2 ], "name": "Bruno Stankoff", "orcid": "0000-0002-9631-4674" }, { "affs": [ 26 ], "name": "Valerie Touitou", "orcid": "0000-0002-0103-2923" }, { "affs": [ 27 ], "name": "Catherine Vignal Clermont" }, { "affs": [ 28 ], "name": "Delphine Sterlin", "orcid": "0000-0002-5993-687X" }, { "affs": [ 5, 6, 23 ], "name": "Romain Marignier", "orcid": "0000-0002-5967-2800" }, { "affs": [ 0, 1 ], "name": "Elisabeth Maillart", "orcid": "0000-0001-7699-0328" }, { "name": "NOMADMUS study group" } ], "bibtex": "https://research.draconitic.com/paper/6esryq15g5v7p.bib", "cited_by": 0, "doi": "10.1212/nxi.0000000000200662", "fulltext_url": "https://europepmc.org/articles/PMC13693801", "id": "6esryq15g5v7p", "issns": [ "2332-7812" ], "landing_url": "https://europepmc.org/article/MED/42912878", "language": "eng", "licence": "CC-BY-NC-ND", "licence_label": "CC BY-NC-ND", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/", "metadata_licence": null, "native_subjects": [ [ "hal", "0.scco" ], [ "hal", "0.sdv" ], [ "hal", "1.scco.neur" ], [ "hal", "1.sdv.mhep" ], [ "openalex", "2734|Multiple Sclerosis Research Studies" ] ], "openalex": "W7223216327", "pdf_url": "https://europepmc.org/articles/PMC13693801?pdf=render", "pmcid": "PMC13693801", "pmid": "42912878", "published": "2026-10-22", "publisher": "American Academy of neurology", "ris": "https://research.draconitic.com/paper/6esryq15g5v7p.ris", "sources": [ { "first_seen": "2026-10-30T12:20:10Z", "native_id": "MED:42912878", "source": "europepmc", "url": "https://europepmc.org/article/MED/42912878" }, { "first_seen": "2026-10-31T12:20:56Z", "native_id": "hal-05846114", "source": "hal", "url": "https://hal.science/hal-05846114v1" } ], "subjects": [ { "field": "biology", "origin": "hal:1.scco.neur", "subfield": "neuroscience" }, { "field": "medicine", "origin": "hal:1.sdv.mhep", "subfield": "general" } ], "title": "Clear Positive MOG Antibodies in Adults With Multiple Sclerosis Features: Diagnostic Challenges.", "title_text": "Clear Positive MOG Antibodies in Adults With Multiple Sclerosis Features: Diagnostic Challenges.", "type": "peer-reviewed", "updated_at": "2026-11-01T12:20:46Z", "url": "https://research.draconitic.com/paper/6esryq15g5v7p", "venue": "Neurology(R) neuroimmunology & neuroinflammation", "versions": [] }