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Differentiating between MS, NMOSD, and MOGAD - MS Nurse PRO
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Sechi et al., 2022).</p><p>Awareness of the specific features that define each demyelinating disorder is crucial for a nurse in shaping a correct diagnosis and timely initiation of an appropriate treatment together with a neurologist. Hence, the blog will expand on NMOSD and MOGAD, with a focus on how to differentiate them from MS.<br></p><h4><strong>NMOSD</strong></h4><p><a href="https://msnursepro.org/mspedia/nmosd" data-mce-href="https://msnursepro.org/mspedia/nmosd">NMOSD</a> (also known as <a href="https://msnursepro.org/mspedia/glossary/devics-syndromedisease" data-mce-href="https://msnursepro.org/mspedia/glossary/devics-syndromedisease">Devic’s disease</a>) is an autoimmune condition of the CNS, causing inflammation to the optic nerve and spinal cord. It is a rare disease with a worldwide prevalence between 0.5 and 10 per 100,000 persons (Hor et al., 2020). It can occur at any age but appears most often in females between the ages of 30–50 years, with a median age of disease onset at 40 years (Etemadifar et al., 2015).</p><p>NMOSD is a relapsing disease where relapses are followed by periods of some recovery. The most common relapses in NMOSD are optic neuritis, transverse myelitis, and area postrema syndrome, resulting in symptoms including eye pain, loss of vision, muscle weakness, paralysis, loss of bowel and bladder control, and severe nausea, vomiting, and hiccups (taken from <a href="https://www.sumairafoundation.org/what-to-know-about-nmo/" data-mce-href="https://www.sumairafoundation.org/what-to-know-about-nmo/">The Sumaira Foundation</a>).</p><p>Relapses in NMOSD are often very severe and can result in incomplete recovery, leading to an accumulation of damage and permanent disability (Kessler et al., 2016). Preventing attacks through early and ongoing treatment is therefore important to prevent long-term permanent disability.</p><h4><strong>MOGAD</strong></h4><p><a href="https://msnursepro.org/mspedia/mogad" data-mce-href="https://msnursepro.org/mspedia/mogad">MOGAD</a> is an immune-mediated disorder that mainly targets the CNS. It is associated with the presence of antibodies directed against myelin oligodendrocyte glycoprotein (MOG) (Sharma et al., 2022).</p><p>MOGAD appears to be equally common among males and females. It presents in both adults and in children in different ways:</p><ul><li>In children, MOGAD more commonly causes attacks on the brain, resulting in symptoms including confusion, incoordination, double vision, nausea and vomiting.</li><li>In adults, MOGAD often causes damage to the eyes (optic neuritis) and/or spinal cord (transverse myelitis) resulting in symptoms similar to NMOSD (e.g., loss of vision, weakness, paralysis).</li></ul><h4><strong>Differentiating NMOSD and MOGAD from MS</strong></h4><p>The neurological manifestations of NMOSD and MOGAD may mimic those of MS, often leading to misdiagnosis. DMTs used to treat MS can be ineffective against NMOSD, with evidence showing that some can even aggravate it further (Min et al., 2012; Gelfand et al., 2014). It is therefore important to distinguish between these disorders owing to the differences in both therapeutic and diagnostic implications (Fadda et al., 2022).</p><p>The following table highlights some of the differences to look out for between the disorders (Sechi et al., 2022; Fadda et al., 2022):</p><table width="550" class="" style="border-collapse: collapse; width: 100%; height: 481.333px;" data-mce-style="border-collapse: collapse; width: 100%; height: 481.333px;"><tbody><tr style="height: 58px;" data-mce-style="height: 58px;"><td style="height: 58px; width: 16.6348%;" data-mce-style="height: 58px; width: 16.6348%;"><p><strong> </strong></p></td><td style="height: 58px; width: 25.1739%;" data-mce-style="height: 58px; width: 25.1739%;"><h5><span style="font-size: 14pt;" data-mce-style="font-size: 14pt;"><strong>MS</strong></span></h5></td><td style="height: 58px; width: 28.2997%;" data-mce-style="height: 58px; width: 28.2997%;"><h5><span style="font-size: 14pt;" data-mce-style="font-size: 14pt;"><strong>NMOSD (AQP4 +ve_</strong></span></h5></td><td style="height: 58px; width: 29.8917%;" data-mce-style="height: 58px; width: 29.8917%;"><h5><span style="font-size: 14pt;" data-mce-style="font-size: 14pt;"><strong>MOGAD</strong></span></h5></td></tr><tr style="height: 55.7778px;" data-mce-style="height: 55.7778px;"><td style="height: 55.7778px; width: 16.6348%;" data-mce-style="height: 55.7778px; width: 16.6348%;"><h5><span style="font-size: 14pt;" data-mce-style="font-size: 14pt;"><strong>Commonly affected age</strong></span></h5></td><td style="height: 55.7778px; width: 25.1739%;" data-mce-style="height: 55.7778px; width: 25.1739%;"><p>20–40</p></td><td style="height: 55.7778px; width: 28.2997%;" data-mce-style="height: 55.7778px; width: 28.2997%;"><p>30–50</p></td><td style="height: 55.7778px; width: 29.8917%;" data-mce-style="height: 55.7778px; width: 29.8917%;"><p>0–40</p></td></tr><tr style="height: 43px;" data-mce-style="height: 43px;"><td style="height: 43px; width: 16.6348%;" data-mce-style="height: 43px; width: 16.6348%;"><h5><span style="font-size: 14pt;" data-mce-style="font-size: 14pt;"><strong>Sex (female:male)</strong></span></h5></td><td style="height: 43px; width: 25.1739%;" data-mce-style="height: 43px; width: 25.1739%;"><p>2–3:1</p></td><td style="height: 43px; width: 28.2997%;" data-mce-style="height: 43px; width: 28.2997%;"><p>9:1</p></td><td style="height: 43px; width: 29.8917%;" data-mce-style="height: 43px; width: 29.8917%;"><p>1:1</p></td></tr><tr style="height: 43px;" data-mce-style="height: 43px;"><td style="height: 43px; width: 16.6348%;" data-mce-style="height: 43px; width: 16.6348%;"><h5><span style="font-size: 14pt;" data-mce-style="font-size: 14pt;"><strong>Ethnicity</strong></span></h5></td><td style="height: 43px; width: 25.1739%;" data-mce-style="height: 43px; width: 25.1739%;"><p>Any, mostly Caucasian</p></td><td style="height: 43px; width: 28.2997%;" data-mce-style="height: 43px; width: 28.2997%;"><p>Any, African-American and Asian at higher risk</p></td><td style="height: 43px; width: 29.8917%;" data-mce-style="height: 43px; width: 29.8917%;"><p>Any, unclear ethnic differences</p></td></tr><tr style="height: 40px;" data-mce-style="height: 40px;"><td style="height: 40px; width: 16.6348%;" data-mce-style="height: 40px; width: 16.6348%;"><h5><span style="font-size: 14pt;" data-mce-style="font-size: 14pt;"><strong>Disease course</strong></span></h5></td><td style="height: 40px; width: 25.1739%;" data-mce-style="height: 40px; width: 25.1739%;"><p>Relapsing (85%) or progressive from onset (15%); secondary progression can develop in relapsing form</p></td><td style="height: 40px; width: 28.2997%;" data-mce-style="height: 40px; width: 28.2997%;"><p>Relapsing (>95%); progressive course extremely rare</p></td><td style="height: 40px; width: 29.8917%;" data-mce-style="height: 40px; width: 29.8917%;"><p>Relapsing (50%) or monophasic (50%); progressive course is rare</p></td></tr><tr style="height: 55.7778px;" data-mce-style="height: 55.7778px;"><td style="height: 55.7778px; width: 16.6348%;" data-mce-style="height: 55.7778px; width: 16.6348%;"><h5><span style="font-size: 14pt;" data-mce-style="font-size: 14pt;"><strong>Recovery from attacks</strong></span></h5></td><td style="height: 55.7778px; width: 25.1739%;" data-mce-style="height: 55.7778px; width: 25.1739%;"><p>Generally good</p></td><td style="height: 55.7778px; width: 28.2997%;" data-mce-style="height: 55.7778px; width: 28.2997%;"><p>Often incomplete, leading to permanent CNS damage</p></td><td style="height: 55.7778px; width: 29.8917%;" data-mce-style="height: 55.7778px; width: 29.8917%;"><p>Generally good despite severe attacks</p></td></tr><tr style="height: 44px;" data-mce-style="height: 44px;"><td style="height: 44px; width: 16.6348%;" data-mce-style="height: 44px; width: 16.6348%;"><h5><span style="font-size: 14pt;" data-mce-style="font-size: 14pt;"><strong>Key symptoms</strong></span></h5></td><td style="height: 44px; width: 25.1739%;" data-mce-style="height: 44px; width: 25.1739%;"><p>Often fatigue or cognitive impairment</p></td><td style="height: 44px; width: 28.2997%;" data-mce-style="height: 44px; width: 28.2997%;"><p>Severe vision impairment</p></td><td style="height: 44px; width: 29.8917%;" data-mce-style="height: 44px; width: 29.8917%;"><p>Vision impairment, often with better recovery than in NMOSD</p></td></tr><tr style="height: 55.7778px;" data-mce-style="height: 55.7778px;"><td style="height: 55.7778px; width: 16.6348%;" data-mce-style="height: 55.7778px; width: 16.6348%;"><h5><span style="font-size: 14pt;" data-mce-style="font-size: 14pt;"><strong>Area postrema syndrome</strong></span></h5></td><td style="height: 55.7778px; width: 25.1739%;" data-mce-style="height: 55.7778px; width: 25.1739%;"><p>Rare</p></td><td style="height: 55.7778px; width: 28.2997%;" data-mce-style="height: 55.7778px; width: 28.2997%;"><p>Sometimes seen</p></td><td style="height: 55.7778px; width: 29.8917%;" data-mce-style="height: 55.7778px; width: 29.8917%;"><p>Rare</p></td></tr><tr style="height: 43px;" data-mce-style="height: 43px;"><td style="height: 43px; width: 16.6348%;" data-mce-style="height: 43px; width: 16.6348%;"><h5><span style="font-size: 14pt;" data-mce-style="font-size: 14pt;"><strong>Encephalopathy</strong></span></h5></td><td style="height: 43px; width: 25.1739%;" data-mce-style="height: 43px; width: 25.1739%;"><p>Rare</p></td><td style="height: 43px; width: 28.2997%;" data-mce-style="height: 43px; width: 28.2997%;"><p>Rare</p></td><td style="height: 43px; width: 29.8917%;" data-mce-style="height: 43px; width: 29.8917%;"><p>Sometimes seen</p></td></tr><tr style="height: 43px;" data-mce-style="height: 43px;"><td style="height: 43px; width: 16.6348%;" data-mce-style="height: 43px; width: 16.6348%;"><h5><span style="font-size: 14pt;" data-mce-style="font-size: 14pt;"><strong>AQP4</strong></span></h5></td><td style="height: 43px; width: 25.1739%;" data-mce-style="height: 43px; width: 25.1739%;"><p>AQP4 antibody seronegative</p></td><td style="height: 43px; width: 28.2997%;" data-mce-style="height: 43px; width: 28.2997%;"><p>AQP4 antibody seropositive</p></td><td style="height: 43px; width: 29.8917%;" data-mce-style="height: 43px; width: 29.8917%;"><p><br></p></td></tr></tbody></table><h4><strong><br></strong></h4><p><span style="font-size: 12pt;" data-mce-style="font-size: 12pt;">The presence of aquaporin 4 (AQP4) antibodies is very specific to a diagnosis of NMOSD, with the antibody being detected in up to 80% of patients with NMOSD. More stringent clinical criteria, with additional neuroimaging findings, are required for diagnosis of NMOSD without AQP4-IgG or when serologic testing is unavailable (Wingerchuk et al., 2015).</span></p><h4><strong>Find out more...</strong></h4><p>For more information about NMOSD and MOGAD, visit <a href="https://www.sumairafoundation.org/" data-mce-href="https://www.sumairafoundation.org/">The Sumaira Foundation</a>. The Sumaira Foundation is dedicated to raising global awareness of NMOSD and MOGAD, building communities of support for patients and their caregivers, funding research and patient advocacy.</p><h4>Literature </h4><ol><li>Lennon VA, <em>et al</em>. <em>Lancet</em> 2004;364:2106–2112</li><li>Sechi E, <em>et al</em>. <em>Front Neurol</em>. 2022;13:885218</li><li>Glisson C. Neuromyelitis optica spectrum disorders. UpToDate. Available at <a href="https://www.uptodate.com/contents/neuromyelitis-optica-spectrum-disorders." data-mce-href="https://www.uptodate.com/contents/neuromyelitis-optica-spectrum-disorders.">https://www.uptodate.com/contents/neuromyelitis-optica-spectrum-disorders.</a> Accessed 02/12/22</li><li>Hor JY, <em>et al</em>. <em>Front Neurol</em>. 2020;11:501</li><li>Etemadifar M, <em>et al</em>. <em>Mult Scler Int</em>. 2015;2015:174720</li><li>The Sumaira Foundation. What to know about NMO. Available at <a href="https://www.sumairafoundation.org/what-to-know-about-nmo/" data-mce-href="https://www.sumairafoundation.org/what-to-know-about-nmo/">https://www.sumairafoundation.org/what-to-know-about-nmo/</a> Accessed 02/12/22</li><li>Kessler RA, <em>et al</em>. <em>Neurol Neuroimmunol Neuroinflamm</em>. 2016;3:e269</li><li>Sharma G, <em>et al</em>. <em>Curr Protein Pept Sci</em>. 2022;23:384–394</li><li>Min JH, <em>et al</em>. <em>Mult Scler</em>. 2012;18:113</li><li>Gelfand JM, <em>et al</em>. <em>Neurol Neuroimmunol Neuroinflamm</em>. 2014;1:e34</li><li>Fadda G, <em>et al</em>. <em>Front Neurol</em>. 2022;13:1011579</li><li>Wingerchuk DM, <em>et al</em>. <em>Neurology</em> 2015; 85:177–189<br></li></ol></div> </div> </div> </div> </section> </div> <div class="mt-3 p-3 mb-3"> <a href="https://msnursepro.org/tags/educational-reads"><span class="badge bg-info">Educational reads</span></a> </div> </section> <footer class="mt-5"> <div class="footer-grad gradient-bg"></div> <div class="footer-inner innerpage row"> <div class="col-lg-3 col-md-6 mt-3"> <div class="gs-logo"> <a href="https://msnursepro.org"><img alt="ms nurse pro logo" src="https://msnursepro.org/ip/150/storage/images/msnp-logo.png"/></a> </div> </div> <div class="col-lg-3 col-md-6 mt-3"> <div class="h5 text-capitalize">Resources</div> <div class="d-flex flex-column"> <a alt="Blog" rel="noopener" class="-item " href="https://msnursepro.org/blog" > Blog </a> <a alt="Learn" rel="noopener" class="-item " href="https://msnursepro.org/courses" > Learn </a> <a alt="FAQ" rel="noopener" class="-item " href="https://msnursepro.org/faq" > FAQ </a> <a alt="MSPEDIA" rel="noopener" class="-item " href="https://msnursepro.org/mspedia" > MSPEDIA </a> <a alt="Endorsements" rel="noopener" class="-item " href="https://msnursepro.org/endorsements" > Endorsements </a> <a alt="Accreditations" rel="noopener" class="-item " href="https://msnursepro.org/accreditations" > Accreditations </a> <a alt="Supporters" rel="noopener" class="-item " href="https://msnursepro.org/supporters" > Supporters </a> <a alt="Promotional Materials" rel="noopener" class="-item " href="https://msnursepro.org/promotional-materials" > Promotional Materials </a> </div> </div> <div class="col-lg-3 col-md-6 mt-3"> <div class="h5 text-capitalize">Legal</div> <div class="d-flex flex-column"> <a alt="Log-in" rel="noopener" class="-item " href="https://msnursepro.org/login" > Log-in </a> <a alt="Register" rel="noopener" class="-item " href="https://msnursepro.org/register" > Register </a> <a alt="Privacy" rel="noopener" class="-item " href="https://msnursepro.org/privacy" > Privacy </a> <a alt="Terms" rel="noopener" class="-item " href="https://msnursepro.org/terms" > Terms </a> </div> </div> <div class="col-lg-3 col-md-6 mt-3"> <div id="subscribe" class="h5">Subscribe to newsletter</div> <div class="text-center mb-4"> <div class="mt-2 mb-2"> <a href="https://msnursepro.org/mailing/social/optin/google" class="google-login-btn"> <img src="/images/google-icon.svg" width="20" height="20">Subscribe with Google</a> </div> <div class="mt-2 mb-2"> <a rel="noopener" href="https://msnursepro.org/mailing/social/optin/microsoft" class="microsoft-btn"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 448 512" preserveAspectRatio="" fill="currentColor"><path d="M0 32h214.6v214.6H0V32zm233.4 0H448v214.6H233.4V32zM0 265.4h214.6V480H0V265.4zm233.4 0H448V480H233.4V265.4z"></path></svg> <div>Subscribe with Microsoft</div> </a> </div> </div> </div> </div> </footer> <section class="mt-3 mb-5"> <div class="container"> <div class="row"> <div class="col-md-6 d-flex d-md-flex justify-content-center justify-content-md-start"> <div style="color: #cdcdcd; 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