March 18, 2026

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare neuroimmune condition that affects the brain, eyes and spine. Though it shares similarities with other diseases, it was recently classified as its own disease after information distinguishing it from other conditions was discovered.

Brenda Banwell, M.D., a pediatric neurologist and pediatrician-in-chief at Johns Hopkins Children’s Center, has studied the disease for years, and co-created the Pediatric Multiple Sclerosis, MOGAD and Neuroimmune Disorders Program. She answers common questions about the condition.

What is MOGAD?

Myelin oligodendrocyte glycoprotein antibody-associated disease, more commonly called MOGAD, is a condition that affects children and adults in which the immune system attacks the brain, the nerves connected to the eyes and the spinal cord. 

What are the common symptoms of MOGAD?

1. Vision loss is the most common symptom. A person will also have some pain during eye movement.
2. Spinal cord attack is another common symptom. This involves numbness, tingling or weakness in the arms and legs, depending on the level of the spinal cord involvement. If the lower part of the spinal cord is involved, patients may have difficulty passing urine and have symptoms of loss of bladder control.
3. Acute disseminated encephalomyelitis (ADEM) is the third-most common symptom. With ADEM, a person experiences confusion, often along with:
   • confusion, lack of awareness or, in extreme cases, coma
   • limb weakness
   • visual impairment
   • lack of balance while walking

What are the differences between the symptoms in MOGAD and Multiple Sclerosis (MS)?

To the best of our knowledge, MOGAD shows no symptoms before the first attack. Patients I speak with don’t have any symptoms that occur in the weeks leading up to their first attack.

MS is different. People who don’t know they have MS until their first attack will often tell me they are more tired than their friends, or that their hand went numb for a couple of days, or they couldn’t see well in one eye, but it got better over a week or two.

These observations tell me that MS starts way before the first attack, whereas MOGAD seems to start near the time of attack. 

How common is MOGAD?

We don't know yet how common MOGAD is. That’s because the criteria for making a MOGAD diagnosis were published in 2023, and many clinicians around the world are just now applying them and identifying children and adults who meet them. 

Also, the diagnosis of MOGAD requires the detection of antibodies or proteins in the bloodstream that target myelin oligodendrocyte glycoprotein (MOG). This testing has become reliably available in only about the last five years, and it's still not easily accessible in many parts of the world.

What treatment options are available for MOGAD?

The treatment of MOGAD depends on whether it is a patient’s first symptomatic event or a relapse.

1. First Event: This is when we treat the patient immediately when they come in with the first event of visual loss, confusion or spinal cord symptoms.
   • Treatment with high-dose corticosteroids typically works quickly and reduces inflammation in the brain, the optic nerves or the spinal cord. 
   • If that's not enough, we move to other therapies, often using plasma exchange. In this therapy, we take those MOG antibodies we believe are contributing to the symptoms out of blood circulation — like a dialysis for the bloodstream.
   • We also use intravenous immunoglobulin (IVIG), which introduces antibodies from healthy donors into the blood through IV and can help neutralize the MOG antibodies and reduce inflammation while suppressing the immune system.
   • In addition to that, we can also use tocilizumab or a similar medicine, which is an immunosuppressant that can be lifesaving for someone having a severe MOGAD attack.
2. Relapsing MOGAD: The second treatment instance is for people who experience relapsing MOGAD, and we want to prevent those relapses.
   • We can use IVIG, but in a monthly dose.
   • Sometimes, we use rituximab, an antibody therapy that blocks one particular part of the immune system that triggers the relapse.

At this point, there are no specific treatments for MOGAD that have been approved through the typical regulatory process — by the Food and Drug Administration in the United States, and by the European Medicines Agency in Europe. All therapies right now are guided by specialists that have worked as a community to provide guidelines for the treatment of MOGAD.

Will all people with MOGAD have a relapse?

Not all patients will have a relapsing form of MOGAD. Some people will have one attack, and that appears to be the entire experience they have with MOGAD.

Is MOGAD more commonly seen in children or adults?

MOGAD is probably more common in children. That might change as more adult care providers start to recognize more people with MOGAD because we now have the ability to test for the antibody and use the diagnostic criteria.

What kind of doctor should a person diagnosed with MOGAD see for care?

Anyone with a diagnosis of MOGAD should be referred to either a child or adult neurologist who understands this condition. MOGAD is rare and there are many doctors around the world who would not be familiar with its diagnosis and/or the different treatments and the strategies to manage the condition.

What is the long-term outlook for people diagnosed with MOGAD?

Most patients with MOGAD do well. I can also share that relapsing MOGAD is generally a much more serious condition than cases of one event. When you have relapsing MOGAD, you're most likely going to experience new attacks in the eye, leading to loss of vision. But with current therapies, we seem to be doing better at suppressing those attacks than we were 20 years ago.  

With proper therapy, most of my patients are doing very well, but what I don't know is how they will be doing in 10 or 20 years. We’re going to need to work as a community to figure that out in this era of prompt diagnosis and available treatment.

Why choose Johns Hopkins to receive care for MOGAD?

Our Pediatric Multiple Sclerosis, MOGAD and Neuroimmune Disorders Program is led by world experts who specialize in MOGAD, MS and related disorders. Our team of experts is directly leading diagnostic criteria and therapeutic trials, and offers a comprehensive assessment for all pediatric and adult patients. 

We also partner closely with other Johns Hopkins specialists in neuro-ophthalmology, neuroradiology, neuropsychology, physical medicine and rehabilitation, and rheumatology to address our patients’ needs. We’re proud to offer the compassionate care, research-backed therapies and ongoing support needed for children and families who deal with the challenges of living with MOGAD.

Medically reviewed by Brenda Banwell, M.D.