Temporal Dynamics of MOG Antibodies in Children With Acquired Demyelinating Syndrome

Eva Maria Wendel1, Helen Sophie Thonke1, Annikki Bertolini1

  • 1From the Department of Pediatric Neurology (E.M.W.), Olgahospital/Klinikum Stuttgart; Department of Pediatric Neurology (H.S.T., A. Bertolini, K.R.), Witten/Herdecke University, Datteln, Germany; Department of Pediatric I (M. Baumann, C.L.), Pediatric Neurology, Medical University of Innsbruck, Innsbruck, Austria; LMU Klinikum (A. Blaschek), Hauner Children´s Hospital, Munich; Division of Pediatric Neurology (A.M.), Department of Pediatrics, Medical University of Leipzig; Department of General Pediatrics (M.K.), Neonatology and Pediatric Cardiology, University Childrens Hospital, Heinrich-Heine- University Duesseldorf, Germany; Department of Neurology (B.K.), Medical University Vienna, Austria; Department of Neurology (D.P.), Children's Hospital of Eastern Ontario, University of Ottawa, Canada; Department of Neuropediatrics (M.P.), Children's Hospital DRK Siegen, Germany; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Division of Pediatric Neurology (M. Schimmel), Childrens Hospital, Medical University of Augsburg; Department of Neuropediatrics and Social Pediatrics (C.T.), University Hospital for Children and Adolescent Medicine, Ruhr-University Bochum; Division of Neuropediatrics and Social Pediatrics (S.W.), Childrens Hospital, Cologne; Division of Pediatric Neurology (G.W.), Department of Pediatrics, Asklepios Klinik Nord, Heidberg, Germany; Department of Pediatric Neurology (B.A.), Hacettepe University Faculty of Medicine, Ankara, Turkey; Department of Pediatrics (N.B.), University Hospital Zagreb, Medical University Zagreb, Croatia; Department of Pediatric Neurology (C.B.), Kinderkrankenhaus St. Marien gGmbH, Landshut, Germany; Division of Pediatric Pulmonology (M. Breu), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna; Department of Pediatric Neurology (P.B.), Ostschweizer Kinderspital, St. Gallen, Switzerland; Department of Pediatric Neurology (A.D.M.), Centre for Neuromuscular Disorders, Centre for Translational Neuro- and Behavioral Sciences, University Duisburg-Essen; Department of Pediatric Neurology (K.D.), Children's Hospital Kassel; Department of Neuropediatrics and Muscle Disorders (M.E.), Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; Department of Paediatrics and Adolescent Medicine (A.E.), Johannes Kepler University Linz, Kepler University Hospital, Linz, Austria; Department of Pediatric and Adolescent Medicine (M.F.), Medical University Vienna, Austria; Department of Pediatrics (U.G.-S.), LKH Medical University Graz, Austria; Department of Pediatric Neurology (A.H.), University Children's Hospital, University of Zurich; Zentrum für Kinderneurologie AG (T.I.), Zurich, Schwitzerland; Charité Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Neurology, Germany; Department of Pediatrics (J.K.), Salzburger Landeskliniken (SALK) and Paracelsus Medical University (PMU), Salzburg, Austria; Division of Pediatric Neurology (G.K.), Department of Pediatrics, Caritas-Hospital Bad Mergentheim, Germany; Department of Pediatrics and Adolescent Medicine (S.L.), Hospital Dritter Orden, Munich, Germany; Department of Pediatric Neurology (G.L.), Children's Hospital Altona, Hamburg, Germany; Paediatric Neurology and Neurophysiology Unit (M.N., S.S.), Department of Women's and Children's Health, University Hospital of Padova, Italy; Neuroimmunology Group (M.N., S.S.), Paediatric Research Institute "Città della Speranza," Padova, Italy; Department of Neuropediatrics and Muscle Disorders (A.P.), University Medical Center, Faculty of Medicine, University of Freiburg, Germany; Medical University of Vienna (E.R.-F.), Department of Pediatrics; Department of Neuropediatrics (E.R.-F.), St. Anna Children`s Hospital; Department of Social Medicine (D.R.), Donauspital, Vienna, Austria; Department of Pediatrics (M. Salandin), Division of Pediatric Neurology, Hospital Bozen, Italy; Department of Pediatrics (J.-U.S.), Division of Pediatric Neurology, Gemeinschaftskrankenhaus Herdecke, Medical University Witten, Herdecke, Germany; Department of Pediatrics (J. Stoffels), Division of Neuropediatrics, KJF Klinikum Josefinum, Augsburg, Germany; Neurology Department of Children's University Hospital (J. Strautmanis), Riga Stradins University, Riga, Latvia; Center for Pediatric and Teenage Health Care (D.T.), Child Neurology, Sankt Augustin, Germany; Department of Neuropediatrics (V.T.), University Hospital Carl Gustav Carus, Technische Universität Dresden; and Department of Pediatric Neurology (N.U.), Children's Hospital, Medical University Greifswald, Germany.

Abstract

Insights

Declining myelin oligodendrocyte glycoprotein antibody (MOG-IgG) titers, especially seroconversion to negative, significantly reduce relapse risk in children with MOG antibody-associated disorder (MOGAD). This finding aids in predicting disease course and managing MOGAD.

Area of Science:

  • Neuroimmunology
  • Pediatric Neurology
  • Demyelinating Diseases

Background:

  • Myelin oligodendrocyte glycoprotein antibody-associated disorder (MOGAD) presents with diverse clinical courses, ranging from monophasic to relapsing.
  • Persistently high MOG antibody (MOG-IgG) titers are associated with a relapsing disease course in MOGAD.
  • Prognostic factors for predicting relapse risk in pediatric MOGAD remain underexplored.

Purpose of the Study:

  • To identify clinical and laboratory prognostic parameters for relapse risk in children with MOGAD.
  • To analyze the temporal dynamics of MOG-IgG titers in relation to clinical presentation and disease course.

Main Methods:

  • Prospective multicenter study including 116 children with a first demyelinating attack and MOGAD.
  • Inclusion criteria: complete clinical/radiologic data, MOG-IgG titer at onset, and follow-up data.
  • MOG-IgG titers analyzed via live cell-based assay; ≥1:160 considered positive. Serial testing performed in years 1 and 2 post-event.

Main Results:

  • No significant association found between disease course and MOG-IgG titers at onset, sex, age, or phenotype.
  • Seroconversion to MOG-IgG-negative within 2 years significantly reduced relapse risk.
  • Monophasic patients showed decreasing MOG-IgG titers and frequent seroconversion, unlike relapsing patients with persistently high titers.

Conclusions:

  • Declining MOG-IgG titers, particularly seroconversion to negative, are strong indicators of a reduced relapse risk in pediatric MOGAD.
  • Temporal dynamics of MOG-IgG titers are crucial for predicting the long-term clinical course of MOGAD in children.
  • No relapses occurred after seroconversion to MOG-IgG-negative in the studied cohort.