What is MOGAD? Let's learn about this disease that damages our own body parts!

Have you ever wondered how the immune system, which is like a soldier protecting us from diseases, can sometimes go astray and attack our own healthy parts? Unfortunately, this is a disease caused by a problem that occurs inside our body. While this may sound a bit complicated, let's keep it simple because it's important to be aware of it.

What exactly is MOGAD?

Simply put, MOGAD is an autoimmune condition . Now you may be wondering what it is. The main function of our body's immune system is to protect us from diseases by fighting germs, viruses, and bacteria that come from outside. This is helped by a special type of protein called antibodies . But sometimes, this immune system goes wrong. Then they start to recognize our own healthy cells and tissues as enemies and attack them. That's what we call an autoimmune condition.

That's what happens in MOGAD. Here, our immune system attacks the protective covering around our central nervous system (CNS) , which is the brain, spinal cord, and optic nerves in our eyes. This protective covering is called myelin . Think of it like the plastic sheath around an electrical wire. This myelin protects the nerve fibers and helps nerve signals travel smoothly.

So, when antibodies come and damage this myelin, we call it demyelination . Just like when the plastic covering on that wire is damaged, the light doesn't turn on properly, when the myelin is damaged, the messages from the brain to the rest of the body don't go through properly. This is why MOGAD causes various symptoms.

Common symptoms include loss of vision or blurred vision (Optic Neuritis) , muscle weakness (Transverse Myelitis) , and loss of balance (Acute Disseminated Encephalomyelitis - ADEM) . If a doctor calls you by these names, you'll now know what they mean.

Are there main types of MOGAD?

Yes, we can see two main types of MOGAD:

1. Monophasic MOGAD: In this case, you only experience symptoms once. That is, once you get the disease and are treated, the symptoms do not appear again.

2. Relapsing MOGAD: This is a little different. Symptoms may disappear for a while (we call this remission) , but then recur. It appears to be a chronic condition.

Is MOGAD a rare disease?

What does MOGAD actually mean?A relatively rare demyelinating disorder . But as awareness of the disease increases, doctors believe that the number of cases will likely increase in the future. Based on current data, it is estimated that about one to three people in a million people develop the disease each year. That means it is not a very common disease.

What are the symptoms of MOGAD?

Symptoms of MOGAD can affect many parts of your body. The main ones are the eyes, spinal cord (the nerve cord inside the spine), and brain.

Symptoms affecting the eyes (Optic Neuritis)

We call this condition Optic Neuritis . It can affect one or both eyes.

• Blurred vision
• Double vision
• Partial or complete loss of vision
• Eye pain , especially when moving the eyes
• Color vision loss

Imagine, suddenly losing your vision in one eye, or everything becoming blurry. That's what an experience can be like.

Symptoms affecting the spinal cord (Transverse Myelitis)

This is called transverse myelitis . This is inflammation of the spinal cord.

• Muscle weakness , possibly even inability to walk
• Numbness or loss of sensation in some parts of the body
• Loss of bowel or bladder control (e.g., inability to hold urine, inability to control bowel movements)
• Difficulty completely voiding urine
• Muscle stiffness or twitching (spasticity)
• A sharp, stabbing pain or a tingling sensation in the neck, back, or abdomen .

This is like damage to the main cable that carries messages in our body.

Symptoms affecting the brain (ADEM)

We call symptoms that affect the brain Acute Disseminated Encephalomyelitis (ADEM) .

• Confusion , feeling like your consciousness is wandering
• Loss of balance and coordination , may sway like a drunk person
• Headache
• Behavioral changes , such as becoming irritable or agitated
• Loss of consciousness
• Epilepsy symptoms (Seizures) , that is, seizures.

MOGAD symptoms can be relapsing. That is, there may be periods of no symptoms and then suddenly symptoms reappear (relapse).

Are the symptoms of MOGAD different for adults and children?

Yes, the way symptoms manifest may change slightly with age.

Usually, when children develop MOGAD, it mainly affects the brain (ADEM condition). Then the symptoms mentioned earlier, such as confusion and loss of balance, are most often seen. Sometimes, vision problems (Optic Neuritis) can also occur at the same time.

When adults develop MOGAD, it most often targets the spinal cord (Transverse Myelitis) and the eyes (Optic Neuritis). Therefore, they often experience symptoms such as weakness, numbness, and blurred vision.

What caused the formation of MOGAD?

To be honest, the exact cause of MOGAD has not yet been found . It is currently believed that this is not a hereditary disease or a disease caused by a genetic cause. There is also research on whether it starts due to a change in the immune system, such as after a viral infection. But it is not yet possible to say for sure that this is the cause.

What are the possible complications of MOGAD?

Damage to that protective covering called myelin can have permanent effects on how our bodies function. Some of the complications that sometimes occur include:

• Becoming completely blind
• Permanent loss of bladder or bowel function
• Paralysis
• Chronic pain
• Chronic fatigue , feeling tired all the time
• Cognitive impairment , which means difficulty learning, remembering, and thinking.

Living with MOGAD alone can be really difficult to manage. When symptoms arise, they can take you away from the things you enjoy doing and make you feel helpless. As a result, many people with MOGAD also suffer from mental health issues like depression. So, if you are feeling this way, it is important to talk to a doctor about it.

How is MOGAD disease diagnosed?

A doctor will diagnose MOGAD by performing a physical exam , a neurological exam , and some other specialized testing . During the exam, he or she will ask about your symptoms and your medical history.

Tests that help confirm the presence of MOGAD disease include:

• Check if the number of white blood cells in the blood has increased (this is something that happens when there is inflammation).
• Whether there are any lesions in the brain or spinal cord (these can be checked with MRI scans).
• Oligoclonal bandsThese are not usually seen in MOGAD, but are seen in some other diseases (e.g., multiple sclerosis). This can help differentiate the two diseases.

Some tests that are useful in diagnosing MOGAD are:

• Blood tests: Check for antibodies specifically against a protein called MOG (MOG-IgG antibodies).
• Vision exam: Check for inflammation of the optic nerve.
• Lumbar puncture: This involves taking a small amount of cerebrospinal fluid from the spine and testing it. This is also called a "spinal tap."
• MRI (Magnetic Resonance Imaging) scan: This can take detailed pictures of the brain and spinal cord and look for lesions in the myelin.

MOGAD can sometimes be difficult to diagnose, as its symptoms can be similar to those of other neurological diseases, such as multiple sclerosis (MS) . Therefore, it can take some time and several tests to make an accurate diagnosis.

At what age is MOGAD usually diagnosed?

Most people are diagnosed with MOGAD in their twenties or thirties . However, the condition can affect anyone at any age. Children are most often diagnosed before the age of 11 .

Can MOGAD be completely cured?

Unfortunately, there is no cure for MOGAD at this time . That is, there is no cure that can completely eliminate the disease from the body. But, fear not! There are treatments that can help control symptoms, reduce their frequency, and maintain a good quality of life.

How is MOGAD treated?

When MOGAD symptoms suddenly worsen (acute attack), there are several treatments available:

• Steroids, such as methylprednisolone: ​​These are given intravenously for three to five days. This can help reduce inflammation quickly and control symptoms.
• Plasma exchange: This is a slightly more complex treatment. In this, a machine removes the liquid part of your blood called plasma, separates it from the blood cells, and then injects a replacement fluid, along with your blood cells, back into your body. This helps remove harmful antibodies.
• Intravenous Immunoglobulin (IVIG):This involves replacing the antibodies in your blood with healthy antibodies from donors through a vein. This can also control the action of those antibodies that are malfunctioning.
• Immunosuppressant medications: These are given as pills taken by mouth. They reduce the activity of the immune system and help stop further damage.

Some medications are also used as long-term treatment to prevent relapses of MOGAD symptoms:

• Immunosuppressant medications (other types to continue using)
• Mycophenolate mofetil
• Rituximab
• Azathioprine
• IVIG (intravenous immunoglobulin) infusions or subcutaneous immunoglobulin injections

All of these treatments can have some side effects. Your doctor will explain all of these to you before you start treatment. It's important to let your doctor know if you notice anything new.

Sometimes, if the disease causes complications, your doctor may recommend that you participate in rehabilitation programs . For example, if myelin damage has affected your vision or walking, these rehabilitation programs can help you learn to do daily activities and get around independently.

What is the prognosis of MOGAD disease?

The prognosis for MOGAD is still being studied. However, the outlook for most patients is good . Some people may experience permanent vision changes. Also, some treatments (such as long-term use of immunosuppressant drugs) can increase your risk of side effects such as infections. Therefore, it is important to follow your doctor's instructions and have regular check-ups.

Does MOGAD affect lifespan?

MOGAD does not directly affect your lifespan . Many other factors affect a person's lifespan. Depending on your situation, you can get the most up-to-date information about this from your doctor.

Can MOGAD be prevented?

Unfortunately, there is no known way to prevent MOGAD . This is still being researched. Your doctor may suggest that you take part in clinical trials to learn about new treatments and prevention methods.

When should I see a doctor?

If you experience any of the following, see a doctor immediately:

• If symptoms appear suddenly.
• If you notice a change in your eyesight.
• If you have problems with your ability to walk and move around.
• If symptoms worsen after treatment.
• If you experience side effects from treatment.

You know your body best. If something doesn't feel right, don't hesitate to talk to your doctor about it.

If you experience symptoms of epilepsy (seizure) for the first time, call an emergency room immediately.

What questions should I ask my doctor?

It's normal to have a lot of questions on your mind when you receive a diagnosis of MOGAD.

• "What kind of treatment is recommended for me?"
• "Do I need long-term treatment?"
• "What are the side effects of the treatment?"
• "What do I do if my symptoms suddenly worsen?"

Don't be afraid to ask these questions. After receiving a diagnosis of MOGAD, it's normal to feel overwhelmed by thoughts like, "What happens next?" and "When will the symptoms return?" When you're living with a condition where the cause is not known, that uncertainty can take a toll on your mental health. While many things are uncertain, remember that your medical team is there to ease your fears and answer your questions. They can help you manage your symptoms when they occur and take steps to reduce your risk of future flare-ups.

What we want to take home from this story (Take-Home Message)

MOGAD is a somewhat complex and rare disease. But it is important to be aware of it and understand the symptoms. Remember, this is not a disease that is your fault.

• If you experience sudden changes in your vision, weakness, or numbness , see a doctor immediately.
• With proper diagnosis and treatment, symptoms of MOGAD can be well controlled.
• Although there is no cure, there are ways to maintain a good quality of life with the disease.
• If you're feeling down or depressed, talk to a doctor or someone you trust about it. You're not alone.

I hope this information has helped you gain some understanding of MOGAD. Stay healthy!

` MOGAD, autoimmune diseases, myelin, nervous system, optic neuritis, transverse myelitis, ADEM