Late-onset myelin oligodendrocyte glycoprotein antibody-associated disease: an underrecognized entity in clinical practice; what does its course in later life teach us? A case report and narrative review

Purpose
Myelin oligodendrocyte glycoprotein-associated disease (MOGAD) is an autoimmune demyelinating disorder of the central nervous system, presenting as optic neuritis, transverse myelitis, or acute disseminated encephalomyelitis. In 2023, international diagnostic criteria were established, integrating clinical, laboratory, and magnetic resonance imaging (MRI) findings. This narrative review summarizes current knowledge on late-onset MOGAD (LO-MOGAD), emphasizing its distinct clinical features, diagnostic difficulties, and treatment aspects compared to earlier-onset cases.

Case description
A 60-year-old man developed bilateral optic neuritis, tested positive for MOG immunoglobulin G antibodies, and exhibited a demyelinating lesion in the cervical spinal cord. Five years earlier, he experienced progressive binocular vision loss. Brain MRI revealed non-enhancing supratentorial white matter lesions, and spinal MRI showed a lesion from C3-C5. Anti-aquaporin-4 antibodies and oligoclonal bands were absent.

Comment
LO-MOGAD often presents with subacute onset, bilateral optic neuritis, and short-segment myelitis. Age-related comorbidities and inconsistent study protocols complicate diagnosis and management, highlighting the need for age-specific research.