Investigating the 2023 MOGAD Criteria in Children and Adults With MOG-Antibody Positivity Within and Outside Attacks
Elianet Fonseca, Gemma Olivé-Cirera, Eugenia Martínez‐Hernández, Mar Guasp, Laura Naranjo, Raquel Ruiz‐García, Eva Caballero, Verónica González-Álvarez, Verónica Delgadillo, Gemma Romeu, Cristina del-Prado-Sánchez, José María Cabrera‐Maqueda, Julián Benito‐León, Cristina Íñiguez, José Manuel García‐Domínguez, Carmen Calles, Antonio Cano‐Vindel, Gary Álvarez-Bravo, Inés González‐Suarez, Celia Oreja‐Guevara, Marta Fernández Ros, Jorge Millán‐Pascual, José Meca-Lallana, Laura Borrega Canelo, Jesús Martín-Martínez, María Palao, J. Gracia Gil, Ramón Villaverde, Sara Llufriú, Yolanda Blanco, Albert Saiz, Josep Dalmau, María Sepúlveda, Thaís Armangué, for the Spanish MOGAD study group
Abstract
BACKGROUND AND OBJECTIVES: The 2023 criteria for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) perform well in adults but have not been assessed in children. METHODS: This prospective observational nationwide study includes children and adults with demyelinating syndromes or encephalitis, whose serum or CSF was found MOG-immunoglobulin G (IgG) positive at Institut d'Investigacions Biomèdiques August Pi i Sunyer-Hospital Clínic of Barcelona (Spain). Exclusion criteria were lack of clinical information and follow-up <1 year, and serum unavailable for antibody testing. The primary outcome was to assess the accuracy of the 2023 MOGAD criteria, using as gold standard the most plausible diagnosis after a follow-up >1 year. MOGAD criteria were retrospectively applied assessing core syndromes, supportive clinical-radiological features, and MOG-IgG titers. Patients tested ≤3 months of a disease attack (acute phase) or afterward (remission) were considered separately. The positive predictive value (PPV) of the criteria (true-positive [patients classified as MOGAD and MOGAD diagnosis last follow-up] divided by total positive [all patients classified as MOGAD]), and its 95% CI, was calculated with the Wilson procedure. RESULTS: = 0.038), the PPV was high in both settings (99% [95% CI 97-100] vs 98% [95% CI 89-100]). DISCUSSION: The 2023 MOGAD criteria correctly identified most children and adults with MOGAD. The highest accuracy occurred when they were applied during disease attacks. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that the 2023 MOGAD criteria accurately identify adults and children with MOGAD.