- Cell-based assays are recommended
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- Testing in serum is optimal, although CSF holds promise but needs further study
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- Titers are useful, when available, as high titers are more predictive of MOGAD
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- Testing is best performed during an acute attack and prior to immunotherapy, as titers can drop if tested between attacks or after immunosuppressant use
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- False positives are recognized to occur, particularly at low titer and when the antibody is ordered in low-probability situations
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- Testing should focus on those with the suspicious clinical and radiologic phenotypes, although there should be a lower threshold to test in children
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- Uniform screening of all MS patients for MOG-IgG is not recommended and will increase the risk of false positives
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- Persistence of MOG-IgG over time predicts a higher likelihood of a relapsing over monophasic disease and with the latter, many will revert to seronegative
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