Clear Positive MOG Antibodies in Adults With Multiple Sclerosis Features: Diagnostic Challenges.

@article{garcia2026clear,
  title = {{Clear Positive MOG Antibodies in Adults With Multiple Sclerosis Features: Diagnostic Challenges.}},
  author = {Jeanne Garcia and Natalia Shor and Clemence Boutiere and Julie Pique and Marine Boudot De La Motte and Maxime Guillaume and Adrien Delourme and Helene Zephir and Jonathan Ciron and Clarisse Carra-Dalliere and Pauline Buissonnière and Nicolas Mélé and Jennifer Aboab and Mikael Cohen and Adrien Wang and Justine Couturier and Diana Rusu and Eric Thouvenot and David Axel Laplaud and Aurélie Ruet and Bertrand Bourre and Françoise Durand-Dubief and Lakhdar Benyahya and Nicolas Collongues and Laure Michel and Romain Deschamps and Caroline Papeix and Bertrand Audoin and Bruno Stankoff and Valerie Touitou and Catherine Vignal Clermont and Delphine Sterlin and Romain Marignier and Elisabeth Maillart and NOMADMUS study group},
  journal = {Neurology(R) neuroimmunology \& neuroinflammation},
  year = {2026},
  month = oct,
  doi = {10.1212/nxi.0000000000200662},
  url = {https://europepmc.org/article/MED/42912878},
  note = {CC BY-NC-ND},
}

TY  - JOUR
TI  - Clear Positive MOG Antibodies in Adults With Multiple Sclerosis Features: Diagnostic Challenges.
AU  - Jeanne Garcia
AU  - Natalia Shor
AU  - Clemence Boutiere
AU  - Julie Pique
AU  - Marine Boudot De La Motte
AU  - Maxime Guillaume
AU  - Adrien Delourme
AU  - Helene Zephir
AU  - Jonathan Ciron
AU  - Clarisse Carra-Dalliere
AU  - Pauline Buissonnière
AU  - Nicolas Mélé
AU  - Jennifer Aboab
AU  - Mikael Cohen
AU  - Adrien Wang
AU  - Justine Couturier
AU  - Diana Rusu
AU  - Eric Thouvenot
AU  - David Axel Laplaud
AU  - Aurélie Ruet
AU  - Bertrand Bourre
AU  - Françoise Durand-Dubief
AU  - Lakhdar Benyahya
AU  - Nicolas Collongues
AU  - Laure Michel
AU  - Romain Deschamps
AU  - Caroline Papeix
AU  - Bertrand Audoin
AU  - Bruno Stankoff
AU  - Valerie Touitou
AU  - Catherine Vignal Clermont
AU  - Delphine Sterlin
AU  - Romain Marignier
AU  - Elisabeth Maillart
AU  - NOMADMUS study group
PY  - 2026
DA  - 2026/10/22
JO  - Neurology(R) neuroimmunology & neuroinflammation
DO  - 10.1212/nxi.0000000000200662
UR  - https://europepmc.org/article/MED/42912878
AB  - Background and objectives  Distinguishing 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  We 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  Among 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  Clear 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.
SN  - 2332-7812
ER  -