Paediatric multiple sclerosis and other acute demyelinating diseases

Area of Science:

• Pediatric neuroimmunology
• Autoimmune white matter diseases
• Neuroinflammation in children

Background:

• Neuroimmunological diseases in children are diverse, including grey and white matter disorders.
• Advances include understanding N-methyl D-aspartate receptor-R encephalitis and autoimmune white matter diseases like pediatric multiple sclerosis (pedMS).
• Acute demyelinating syndromes (ADS) associated with myelin-oligodendrocyte-glycoprotein (MOG) antibodies are increasingly recognized.

Purpose of the Study:

• To review recent findings in pedMS.
• To discuss non-MS acute demyelinating episodes linked to MOG antibodies.
• To explore insights from advanced imaging techniques like diffusion tensor imaging (DTI) in pediatric ADS.

Main Methods:

• Review of recent clinical trials and observational studies in pediatric neuroimmunology.
• Analysis of clinical and radiological characteristics of MOG-associated diseases.
• Inclusion of findings from diffusion tensor imaging (DTI) studies.

Main Results:

• The first pediatric MS trial demonstrated fingolimod's superiority over standard treatments.
• MOG-associated diseases present distinct clinical subtypes, differing from pedMS.
• MOG-antibody-associated disorders respond better to B-cell therapies (e.g., IVIG) than MS first-line treatments.

Conclusions:

• Treatment escalation is recommended for highly active pedMS unresponsive to first-line therapies.
• MOG-spectrum diseases in children encompass monophasic and recurrent subtypes with unique treatment needs.
• Further research into DTI may offer new insights into ADS pathogenesis.