MOGAD Clinic Overview

Damaged and undamaged nerves beside a transparent illustration of the body that highlights the central nervous system. Healthy nerve (right) and nerve with damaged covering (left)

Central nervous system diseases that lead to damage to the outer covering of nerves, called myelin, are called inflammatory demyelinating diseases. Two examples are multiple sclerosis and myelin oligodendrocyte glycoprotein antibody-associated disease, also called MOGAD and MOG.

The MOGAD Clinic helps people with a rare, newly defined condition called myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). It's an autoimmune disorder in which the body's immune system attacks the outer covering of its nerves, called myelin. This leads to inflammation of the brain, optic nerve or spinal cord. Loss of this tissue is sometimes termed demyelination. The symptoms can include vision loss, muscle weakness, stiffness or paralysis, bowel or bladder problems, confusion, seizures, and headaches. Sometimes these symptoms can be confused with those of related disorders, such as multiple sclerosis.

Our practice offers the first multidisciplinary clinic in the world, to our knowledge, that is devoted specifically to this disease.

Our world-renowned experts offer services at Mayo Clinic in Jacksonville, Florida; Phoenix/Scottsdale, Arizona; and Rochester, Minnesota. We match you with the MOGAD team that best fits your unique situation. This includes helping to select which location is the most convenient.

Advanced diagnosis and treatment

A quick and accurate diagnosis is key because MOGAD can look like multiple sclerosis (MS), but the two diseases require different approaches. In people with MOGAD, the blood or spinal fluid contains an antibody called myelin oligodendrocyte glycoprotein (MOG) antibody. A positive test for this antibody can confirm the diagnosis. But sometimes this antibody can be found at low levels with other diseases and be a false positive result. That’s why it’s important for experts to determine if you truly have MOGAD.

Knowing what you have affects how you live with it. People with MOGAD can be offered treatment to help treat attacks and prevent future attacks. There are clinical trials underway to identify effective treatments. There also are many symptoms that accompany MOGAD that can be managed in a variety of ways. The Mayo Clinic MOGAD Clinic is uniquely equipped to ensure you have the correct diagnosis and determine the best treatment for you. Timely diagnosis and expert care can make all the difference to the people with this serious and complex condition.

Mayo Clinic doctors have access to an on-site neuroimmunology laboratory that does MOG antibody testing and can help with interpretation of your MOG antibody results. They use the latest imaging and laboratory tools to make a diagnosis and guide treatment. Possible tests you may undergo include:

  • MOG antibody blood test.
  • MRI scans of the head, eyes and spine.
  • Spinal tap.
  • Eye exam.

Our neurologists, radiologists and neurosurgeons are experts in the medical and therapeutic care of people with MOGAD. You may undergo:

  • Oral corticosteroids.
  • Urology procedures.
  • Injections to control spasticity.
  • Plasma exchange.
  • High-dose intravenous steroids.
  • IV immuneglobulin, also called IVIg.
  • Occupational therapy.
  • Physical therapy.

A downward spiral undone: Jon Bratsch

Jon Bratsch: When I was a kid, I would hear a Harley coming. I would run outside and look, always. I've always been kind of a rebel, you know.

Kris Bratsch: So he knows so many people, and they know him. Jon Bratsch? He never gets sick. He's always at work. But, you know, that was always the deal. He always took care of everybody. It was always, Dad, can you come fix it? Dad can fix everything. And then for a long time, he could not.

I had that feeling from day 1. Something is not right. And we've got to keep moving until we figure it out.

Jon Bratsch: I wasn't getting better, and I wasn't getting better. Finally, the doctor said to my wife, I think the best place for him would be Rochester, if he survives the trip.

John Chen, M.D., Ph.D.: We first heard about Jon as this mystery patient. Essentially comatose, quadriplegic, completely paralyzed. So we've got our ICU physicians there just keeping him alive. We didn't know what it was, so we had a brain biopsy. So we had neurosurgery involved. His hormone levels were off, so we had endocrinology involved. But when we started to realize it was more an autoimmune inflammatory condition, that's when we pulled in our neuroimmunologists like Dr. Flanagan, Dr. Pittock, Dr. McKeon, all these experts in Neuroimmunology.

Eoin Flanagan, M.B., B.Ch.: When I met with Mr. Bratsch, I met his wife, and at the time he was very unwell. He was not able to follow any commands. He was on a breathing machine. He was also very weak in his arms and legs and clearly severely confused.

Jon Bratsch: I was pretty sure I was going to die, and I had accepted it. Then every day I'd be like, well, I got one more day, you know. And I went into a coma for eight days.

Dr. Flanagan: We had been given information that his MRI had shown changes that suggested some disease in the white matter. It looked suspicious for some demyelinating disease. But we still weren't sure of the exact cause. So we sent off for an antibody test that we had developed on a research basis in our lab. This is an antibody to myelin oligodendrocyte glycoprotein, or MOG, which is a protein on the surface of oligodendrocytes. Oligodendrocytes are cells within the brain that make our myelin, which is the insulation for our nerves. When those cells get damaged, the insulation goes away and patients have neurologic symptoms.

Dr. Chen: We've got this sample sitting in the lab and we go, gosh, this looks like MOGAD, a brand new disease that's really not well recognized. But we've been seeing patients with a similar phenotype, collecting data, seeing if they all fit a similar phenotype. Drawing blood and trying to perfect an assay against these MOG antibodies.

Dr. Flanagan: Really, when that came back, that gave us the answer. We knew what Mr. Bratsch had and we knew how to treat it.

Dr. Chen: We treated him very aggressively with steroids and we just started slowly tapering down the prednisone and eventually we switched over to mycophenolate.

Dr. Flanagan: With this treatment, he started to improve. This was a very important disease to diagnose because it can affect your thinking and your vision. As a mechanic, it's so important for him to have his dexterity back, to have his vision pristine. And it was partly the aggressive treatment that we were able to do, knowing what we were dealing with and getting him on the right treatment. So we were able to preserve all those functions so he could return to work as a mechanic and to ride his motorcycle without any concerns or without the need for any help.

That just shows you the power of this field of autoimmune neurology where we can really reverse conditions and get people back to the best of their life, back to fully functional.

Dr. Chen: I think anytime a patient is a mystery, it does keep us up at night. But we're not in this alone. Any of our complex patients always have at least two or three other providers thinking about the patient from a different angle.

Dr. Flanagan: The Mayo Clinic is a center of expertise. We want to help patients. We want to see patients like Mr. Bratsch who we can really help.

Dr. Chen: I think that's really what makes Mayo Clinic strong. It's a clinic model where we're all under the same roof, and we really do put the needs of the patient first.

Kris Bratsch: Courtney and I sat outside and cried when he pulled out of the garage with it. It was very emotional because we thought we'd never see him on it again.

Jon Bratsch: I started it up. It felt good. And after that, we just started riding. I've been riding ever since.

A team-based approach

The multidisciplinary approach of the MOGAD Clinic means that you receive evaluation from doctors in various fields and a personalized plan of care in a timely way. The experts of this clinic also offer second opinions. If you wish, the clinic will send a full report to your primary care professional or other referring healthcare professional.

Your MOGAD care is likely to be directed by a doctor who specializes in the nervous system, called a neurologist. Because MOGAD can affect many parts of the body, your care team might include specialists in neuroimmunology, neuro-ophthalmology, physical medicine and rehabilitation, urology, neuropsychology, neuroradiology, pain medicine, or laboratory medicine and pathology. Your team works together to make sure you get exactly the care you need.

Because children are more likely to get MOGAD, access to a pediatric MOGAD expert is important. The MOGAD Clinic in Minnesota coordinates with a team of doctors who specialize in conditions that affect children. These doctors are called pediatricians.

Mayo Clinic Children's Center

Highly skilled pediatric experts diagnose and treat all types of conditions in children. As a team, we work together to find answers, set goals and develop a treatment plan tailored to your child's needs.

Learn more about the Children's Center.

Expertise and rankings

Mayo Clinic has the world's foremost MOGAD experts and is a major referral center for this rare condition. Each year our experts evaluate more than 100 adults and children with MOGAD. The clinic is recognized as an expert center for children with MOGAD. Because so many people come to us for help with this condition, our experts are familiar with the many ways this disease can affect the body. This is key to selecting the best treatment for you.

Our team members are part of the medical advisory board of the MOG Project. It's a grassroots nonprofit patient advocacy organization that aims to connect affected people with medical information and resources to improve their lives.

Mayo Clinic in Rochester, Minnesota, Mayo Clinic in Phoenix/Scottsdale, Arizona, and Mayo Clinic in Jacksonville, Florida, rank among the Best Hospitals for neurology and neurosurgery in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic Children's Center in Rochester is ranked the No. 1 hospital in Minnesota, and the five-state region of Iowa, Minnesota, North Dakota, South Dakota and Wisconsin, according to U.S. News & World Report's 2024-2025 "Best Children's Hospitals" rankings.

Learn more about Mayo Clinic's neurology and neurosurgery departments' expertise and rankings.

Research and innovation

Mayo Clinic physician-scientists are worldwide leaders in advancing the understanding of MOGAD. They identified the symptoms and MRI aspects that can help doctors recognize MOGAD and distinguish it from other diseases, such as multiple sclerosis and neuromyelitis optica spectrum disorder, also called NMOSD. Our experts are committed to doing research that improves diagnosis and treatment for people with this disease. Mayo doctors have published numerous research studies on the topic and were part of the international group that established the diagnostic criteria for the condition in 2023.

Our doctors apply proven breakthrough discoveries to the care of people they see in the MOGAD Clinic. In 2017, Mayo Clinic was the first to develop a MOG antibody test in the United States. Talk with your doctor about potential new diagnostic and therapeutic advances that might benefit you and whether you are eligible for any clinical trials and other research studies.

MOGAD clinical trials

Publications

See a list of publications about MOGAD by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine.

Research profiles

Appointments

You may be referred by your primary care professional, or you may make an appointment without a referral.

Contact

Arizona

  • MOGAD Clinic
  • Neurology Department
  • Mayo Clinic
    13400 E. Shea Blvd.
    Scottsdale, AZ 85259
  • Phone: 480-301-8100

Florida

  • MOGAD Clinic
  • Neurology Department
  • Mayo Clinic
    4500 San Pablo Road
    Jacksonville, FL 32224
  • Phone: 904-953-0856

Minnesota

  • MOGAD Clinic
  • Neurology Department
  • Mayo Clinic
    200 First St. SW
    Rochester, MN 55905
  • Phone: 507-284-2111
Nov. 22, 2024