How do you approach the management of patients with one clinical demyelinating event and MOG+ antibody status?

I do not always treat a MOG+ single event (isolated optic neuritis, isolated transverse myelitis, or ADEM-like presentation) as it is possible that it might be a one-time-only event (as might occur after a viral illness or vaccination).

If there has been "dissemination in time", then I would consider treatment, though as mentioned in other responses we do not know how best to treat MOGAD. It has been my practice to use B-cell therapies or IVIG, but this is based on scant evidence.

As Dr. @Dr. First Last and Dr. @Dr. First Last described, this is a great but tough question. As we know, all patients with MOGAD do not have a relapsing disease course, but I think it is also important to consider that the relapsing course of MOGAD can be very different than other demyelinating diseases; some patients have a highly steroid-dependent relapsing course and others seem to do just fine after weaning steroids, only to relapse months, years, or even decades later. I personally saw a p...

I typically treat this group of patients. The antibody titer levels are perhaps important to correlate with disease phenotype but because antibodies fluctuate, it is almost impossible to predict if the patient will have another demyelinating event and have a catastrophic event. Since MOGAD has no FDA-approved disease modifying therapies, I am forced to treat with non-approved medications such as Rituxan or CellCept.