Comparison of clinical features of aquaporin-4 positive neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein associated disorder (MOGAD), and double seronegative NMOSD - A single center experience

This retrospective study investigates Aquaporin-4 Antibody Positive Neuromyelitis Optica Spectrum Disorder (NMOSD), Myelin Oligodendrocyte Glycoprotein Associated Disorder (MOGAD), and Seronegative NMOSD at a tertiary care university hospital, over a 13 year period (November 2010 to November 2023) involving 78 patients. It distinguishes between the clinical and radiological features of AQP4 + NMOSD (41 patients, 52.5 %), MOGAD (22 patients, 28.2 %), and Seronegative NMOSD (15 patients, 19.3 %). A significant female majority was noted in AQP4+ NMOSD (90.2 %) compared to MOGAD (45.5 %) and Seronegative NMOSD (66.7 %). Age of disease onset and annualized relapse rates were similar across groups. Myelitis was a common initial symptom in AQP4+ NMOSD (48.8 %) and Seronegative NMOSD (40 %), but less so in MOGAD (18.2 %). Optic neuritis was more frequent in MOGAD (68.2 %) and Seronegative NMOSD (53.3 %) than AQP4+ NMOSD (31.7 %). Relapsing disease was less observed in MOGAD (57.1 %) compared to the other groups. Time to the first relapse varied: 12 months for Seronegative NMOSD, 18 months for AQP4+ NMOSD, and 7 months for MOGAD. A higher incidence of autoimmune disorders was found in AQP4+ NMOSD (36.6 %) versus MOGAD (9.5 %). This study delineates a pronounced female and concurrent autoimmune disorder predominance in AQP4+ NMOSD compared to seronegative NMOSD and MOGAD.