Patient handout

Myelin Oligodendrocyte Glycoprotein-Antibody Associated Disease (MOGAD)

PRODUCTION

1. Your condition

This handout is for myelin oligodendrocyte glycoprotein-antibody associated disease (mogad). Your care team identified this based on: mog-igg positive (live cell-based assay) with ≥1 core clinical event per banwell 2023 (pmid 36706773).

Other reasons your team may use this plan: bilateral simultaneous on with severe vision loss + good steroid response — adult mogad typical (banwell 2023 pmid 36706773); acute tm (often conus involvement, short or long-segment; mog-igg+ pivot from tm engine); pediatric encephalopathy + multifocal demyelination + mog-igg+ — adem-like presentation common in pediatric mogad (~60%).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
methylprednisolone	1 g IV daily × 3-5 d adult (30 mg/kg/d × 3-5 d pediatric, max 1 g/d)	IV	daily × 3-5 d	First-line acute pulse; MOGAD highly steroid-responsive (~80% remit); MOG-IgG sample BEFORE steroid if feasible (Banwell 2023 PMID 36706773)
prednisone	60 mg PO daily × 2 wk then taper over 8-12 wk (SLOW)	PO	daily slow taper	MOGAD prone to REBOUND on rapid taper — slow 8-12 wk oral taper recommended after IV pulse; this is distinguishing feature vs MS-flare

Plan: MOGAD acute pulse + course-driven chronic Rx (Banwell 2023 PMID 36706773; PMID 27793206; rituximab PMID 33219036)

3. When to call your provider

Contact your care team if any of the following happen:

Breakthrough relapse on DMT → consider switch (rituximab → tocilizumab or IVIG-monthly)
New ON / myelitis / encephalitis → ED + steroid pulse
IgG <500 + recurrent infection on rituximab → IVIG / pause
Pregnancy confirmed → MS-NMO + MFM coordination
New seizure → AED titrate + EEG

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Bilateral simultaneous ON with severe vision loss + good steroid response — adult MOGAD typical (Banwell 2023 PMID 36706773)
Acute TM with MOG-IgG+ — conus prone, central gray matter, longitudinally extensive variable (Banwell 2023 PMID 36706773)
Pediatric encephalopathy + multifocal demyelination + MOG-IgG+ — most common pediatric MOGAD presentation (~60% pediatric ADEM have MOG)
Brainstem MOGAD with characteristic lesion (oculomotor, ataxia, dysphagia, dysarthria)
Cortical encephalitis MOGAD — seizures + FLAIR cortical hyperintensity (newer recognition; Banwell 2023 PMID 36706773)

5. Follow-up

Rehab (PT/OT/SLP); ophthalmology q3-6 mo if ON; neuropsych if cortical encephalitis or ADEM-phenotype (cognitive deficits); pediatric developmental surveillance if pediatric ADEM; AED management if seizure history; pregnancy planning + postpartum surveillance; MS-NMO-MOGAD specialty clinic q3-6 mo

6. Sources

Guideline: Banwell 2023 MOGAD diagnostic criteria (PMID 36706773) + autoimmune mimics review (PMID 34664709) + MOGAD acute treatment (PMID 27793206) + rituximab MOGAD (PMID 33219036)