Factors Associated With Disability Improvement and Worsening Independent of Attacks in Patients With AQP4-IgG+ NMOSD and MOGAD: A Multicenter Cohort Study
Journal: Neurology; July 2, 2026
Author(s): Daniel Engels, Patrick Schindler, Joachim Havla, Katinka Fischer, Marius Ringelstein, Martin W Hümmert, Franziska Bütow, Insa Schiffmann, Charlotte Schubert, Judith Bellmann-Strobl, Katrin Giglhuber, Clarissa Zappe, Sven Jarius, Lisa Revie , Carolin Schwake, Ioannis Vardakas, Florian Then Bergh, Yavor Yalachkov, Annette Walter, Leila Husseini, Markus C Kowarik, Matthias Grothe, Antonios Bayas, Klemens Angstwurm, Steffen Pfeuffer, Uwe K Zettl, Ingo Kleiter, Clemens Warnke, Simone C Tauber, Jonathan Wickel, Makbule Senel, Ilya Ayzenberg, Luisa Klotz, Brigitte Wildemann, Achim Berthele, Vivien Häußler, Corinna Trebst, Orhan Aktas, Friedemann Paul, Tania Kümpfel ; as the Neuromyelitis Optica Study Group (NEMOS)
Understanding how disability may worsen or improve between relapses in patients with NMOSD and MOGAD
Disability in NMOSD and MOGAD is mainly thought to be associated with relapses. However, improvement or worsening of disability between relapses has not been well studied.
Researchers studied medical information of 307 patients: 202 with AQP4 antibody-positive NMOSD and 105 with MOGAD. They examined repeated scores on the Expanded Disability Status Scale (EDSS), which measures difficulties with functions such as walking, vision, sensation, and coordination. Only periods without relapses were considered. Any improvement or worsening in the disability scores had to continue for at least six months to be counted.
The results showed that in both NMOSD and MOGAD, disability changes between relapses are rare, but possible, and that patients can experience either a worsening or improvement in disability. Younger people were more likely to experience an improvement in disability in both conditions. Among people with AQP4 antibody-positive NMOSD, those who had experienced fewer previous episodes were more likely to show disability improvements between relapses.
More research is needed to study the disease patterns between relapses in NMOSD and MOGAD.
Related article: Time to Disability Milestones and Annualized Relapse Rates in NMOSD and MOGAD
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