Evaluation of diagnostic criteria and red flags of myelin oligodendrocyte glycoprotein encephalomyelitis in a clinical routine cohort

Aims: Myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) have been proposed to define “MOG encephalomyelitis” (MOG-EM), with published diagnostic and “red flag” criteria. We aimed to evaluate these criteria in a routine clinical setting. Methods: We retrospectively analyzed patients with borderline/positive MOG-IgG and applied the diagnostic and red flag criteria to determine likelihood of MOG-EM diagnosis. Para-/clinical parameters were described and analyzed with chi-square test. Results: In total, 37 patients fulfilled MOG-EM diagnostic criteria (female-to-male ratio: 1.6:1, median onset age: 28.0 years [IQR 18.5-40.5], n = 8 with pediatric onset). In 24/37, red flags were present, predominantly MOG-IgG at assay cutoff and/or MRI lesions suggestive of multiple sclerosis (MS). As proposed in the consensus criteria, these patients should rather be described as “possible” MOG-EM. Of these, we classified 13 patients as “unlikely” MOG-EM in the presence of the red flag “borderline MOG-IgG” with negative MOG-IgG retest or coincidence of ≥1 additional red flag. This group mainly consisted of patients diagnosed with MS (n = 11). Frequency of cerebrospinal fluid (CSF-)—specific oligoclonal bands (OCB) is significantly lower in definite vs possible and unlikely MOG-EM (P =.0005). Conclusion: Evaluation of diagnostic and red flag criteria, MOG-IgG retesting (incl. change of assay), and CSF-specific OCB are relevant in clinical routine cohorts to differentiate MOG-EM from MS.