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DEAR DR. ROACH: Over the past 20 years, my now 65-year-old son-in-law has been tentatively diagnosed with Lyme disease, Parkinson’s disease, and multiple sclerosis (MS) without a definitive diagnosis. He has cognitive impairment and some physical limitations. Now, after a spinal tap, they’ve made the diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). What can you tell me about this condition and how it can be treated? -- S.R.
ANSWER: MOGAD is an autoimmune disease of the brain and spinal cord that’s similar in some ways to MS, so the two are often confused. It is a far rarer disease than MS and doesn’t preferentially affect women as MS does. Clinical symptoms of MOGAD typically involve acute attacks of neurological symptoms, but these can be of several different types. One common symptom are eye symptoms, which result in severe visual loss.
A second type of attack is called transverse myelitis, which causes symptoms that may include weakness of the arms or legs (or both); numbness; sexual dysfunction; and the loss of bowel or bladder control. With your son-in-law’s cognitive issues, he may have the pattern of acute disseminated encephalomyelitis, which causes changes in thinking, as well as specific nerve deficits.
The clinical symptoms and MRI can lead an experienced clinician to consider the diagnosis, but it’s the presence of a specific antibody (MOG-IgG) in the blood that confirms the diagnosis. Sometimes there’s cerebrospinal fluid, which gets sampled through a lumbar puncture (“spinal tap”) and also confirms the diagnosis.
The diagnosis can be tricky, and an expert is called for as the clinical features resemble not only MS but a similar set of conditions, called aquaporin-4-immunoglobulin G positive neuromyelitis optica spectrum disorders (NMOSD).
The initial treatment of MOGAD is steroids, as MOGAD tends to be sensitive to steroids. In those in whom steroids aren’t effective, plasma exchange or immune globulin are used. MOGAD can occur only once or cause several attacks, similar to relapsing-remitting MS. Fortunately, MOGAD doesn’t have a progressive course as MS sometimes does.
DEAR DR. ROACH: Is there a problem with taking esomeprazole for the long-term future, and why has it become so expensive through insurers? I used to get it for free. Then, I got a 90-day supply for $10, until my pharmacy put it in their third tier at a cost of $140 for a 90-day supply.
At this point, I began using a GoodRx card and getting it for about $35, then ultimately through Cost Plus Drugs for about $5 plus shipping. I switched to pantoprazole, but it doesn’t work as well. I could easily go back to esomeprazole by using Cost Plus drugs, but I don’t know if I should.
Is there an issue with the long-term use of the drug, or is it strictly a money issue for the insurance company? -- P.R.
ANSWER: This sounds to me like a money issue. Although there are some drug interactions that favor pantoprazole rather than esomeprazole (especially the drug clopidogrel, which can’t be used with esomeprazole but is safe with pantoprazole), most of the time these changes are due to pharmacy benefit managers making deals with pharmaceutical companies. This benefits both of these entities at a cost to the consumer … that is, the patient -- you.
You already know about two of my favorite resources to help with drug costs: plans like GoodRx and the discount pharmacy Cost Plus Drugs. A 90-day supply of the usual dose of esomeprazole is $7.48, plus shipping at CostPlusDrugs.com. Your plan remiburses even less than this, so the company’s making at least a 95% profit margin from people who get their esomeprazole by using their “benefits.” Use the more-effective, less-expensive esomeprazole.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc. All Rights Reserved