Skip to main content
Quest Diagnostics

Demyelinating disorders, including NMOSD, MOG, and MS

Differential diagnosis brings critical clarity to help guide appropriate treatment

Demyelinating disorders of the central nervous system often present with overlapping clinical features, making differential diagnosis an important consideration.

Multiple sclerosis (MS) is one of the most common of these disorders, with diagnoses on the rise.1

Patient presentation can complicate diagnostic evaluation

Patients evaluated for MS often present with nonspecific neurological symptoms—fatigue, vision changes, sensory disturbances, and mobility issues—that can overlap with other demyelinating and autoimmune diseases, such as neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD).

Differential diagnosis is essential

NMOSD and MOGAD may initially resemble MS but require fundamentally different treatment approaches. Accurate distinction between these conditions helps ensure patients receive care that is both appropriate and safe.

Streamline the path from symptoms to diagnosis

The MS Differential Panel from Quest brings together clinically relevant analytes used in the evaluation of demyelinating disease to support accurate identification of MS and exclusion of mimics, such as

  • NMOSD
  • Human T-cell lymphotropic virus (HTLV)
  • Lyme disease (Neuroborreliosis)
  • MOGAD
  • Systemic autoimmune diseases (eg, lupus, rheumatoid arthritis)
  • Vitamin B12 deficiency

Why order demyelinating disease testing from Quest?

Demyelinating disease testing from Quest maintains diagnostic integrity through evidence-based test selection and reflex strategies, helping clinicians distinguish MS from clinically significant mimics. By unifying evaluation within a single, trusted testing strategy, Quest helps streamline the path from symptoms to solution.

A broad test menu that includes AQP4 and MOG antibody testing, supporting clear differentiation among demyelinating disorders

Reflex testing strategies that prioritize clinical relevance—MOG testing is performed only when AQP4 results are negative

Evidence-based pathways designed to avoid unnecessary testing while preserving confidence in results

Research indicates that 15%-35% of patients who test negative for AQP4 test positive for MOG antibodies4-7

Testing that can help deliver clear insights 

Test name

Multiple Sclerosis (MS) Differential Evaluation with Reflexes

Multiple Sclerosis Panel, CSF

Multiple Sclerosis Panel 1, CSF and Serum

Multiple Sclerosis Panel 2, CSF and Serum

NMO Spectrum Evaluation (AQP4 with Reflex to MOG), Serum

NMO Spectrum Evaluation (AQP4 with Reflex to MOG), CSF

Aquaporin-4 (AQP4) (NMO-IgG) Antibody with Reflex to Titer, Serum

Aquaporin-4 (AQP4) (NMO-IgG) Antibody with Reflex to Titer, CSF

MOG Antibody with Reflex to Titer, Serum
MOG Antibody with Reflex to Titer, CSF

References

  1. Abbate, E. Multiple sclerosis diagnoses are rising—and doctors don’t know why. Women’s Health. May 9, 2024. Accessed December 16, 2025. https://www.womenshealthmag.com/health/a60683311/multiple-sclerosis-diagnoses-increasing/
  2. National Multiple Sclerosis Society. How many people live with multiple sclerosis? Accessed December 16, 2025. https://www.nationalmssociety.org/understanding-ms/what-is-ms/who-gets-ms/how-many-people
  3. Avasarala J, Pettigrew C, Sutton P, et al. Can a diagnosis of multiple sclerosis be made without ruling out neuromyelitis optica spectrum disorder? Mult Scler Relat Disord. 2020;40:101949. doi:10.1016/j.msard.2020.101949
  4. Sato DK, Callegaro D, Lana-Peixoto MA, et al. Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders. Neurology. 2014;82(6):474-481. doi:10.1212/WNL.0000000000000101
  5. Kitley J, Waters P, Woodhall M, et al. Neuromyelitis optica spectrum disorders with aquaporin-4 and myelin-oligodendrocyte glycoprotein antibodies: a comparative study. JAMA Neurol. 2014;71(3):276-283. doi:10.1001/jamaneurol.2013.5857
  6. Kezuka T, Usui Y, Yamakawa N, et al. Relationship between NMO-antibody and anti-MOG antibody in optic neuritis. J Neuroophthalmol. 2012;32(2):107-110. doi:10.1097/WNO.0b013e31823c9b6c
  7. Waters P, Woodhall M, O’Connor KC, et al. MOG cell-based assay detects non-MS patients with inflammatory neurologic disease. Neurol Neuroimmunol Neuroinflamm. 2015;2(3):e89. doi:10.1212/NXI.0000000000000089 

Join our email community

Get the very latest news and information from Quest Advanced® Neurology.

Sign up

Our company

Quest® is the brand name used for services offered by Quest Diagnostics Incorporated and its affiliated companies. Quest Diagnostics Incorporated and certain affiliates are CLIA-certified laboratories that provide HIPAA-covered services.  Other affiliates operated under the Quest® brand, such as Quest Consumer Inc., do not provide HIPAA-covered services. 

 

Quest®, Quest Diagnostics®, any associated logos, and all associated Quest Diagnostics registered or unregistered trademarks are the property of Quest Diagnostics. All third-party marks—® and ™—are the property of their respective owners. © 2026 Quest Diagnostics Incorporated. All rights reserved. Image content features models and is intended for illustrative purposes only.