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Slowly Expanding Lesions Differentiate Pediatric Multiple Sclerosis from Myelin Oligodendrocyte Glycoprotein Antibody
Giulia Fadda1, Brenda Banwell2, Colm Elliott3
1Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Abstract:
Slowly expanding lesions (SELs) in adults with multiple sclerosis (MS) indicate a progressive pathological process. Whether SELs are present in pediatric-onset MS (POMS) or myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is unknown. We studied 19 children with POMS and 14 with MOGAD (median age 14.3 and 9.4 years, respectively) recruited to the Canadian Pediatric Demyelinating Disease Study with: (1) ≥3 research scans 12 months apart; and (2) ≥1 T2-lesions on the earliest scan. A total of 70 SELs from 16 POMS participants and 1 SEL in the MOGAD group were detected. SELs are an early feature of POMS and essentially not a feature of MOGAD. ANN NEUROL 2024;96:1086-1091.
Insights
Slowly expanding lesions are an early indicator in pediatric-onset multiple sclerosis (MS). These lesions were found to be uncommon in children with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).
Area of Science:
- Neuroimmunology
- Pediatric Neurology
- Magnetic Resonance Imaging (MRI) in Demyelinating Diseases
Background:
- Slowly expanding lesions (SELs) are recognized as markers of progressive pathology in adult multiple sclerosis (MS).
- The presence and significance of SELs in pediatric demyelinating disorders, specifically pediatric-onset MS (POMS) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), remain uncharacterized.
- Understanding lesion evolution in these pediatric conditions is crucial for diagnosis and prognosis.
Purpose of the Study:
- To investigate the occurrence and characteristics of slowly expanding lesions (SELs) in pediatric-onset multiple sclerosis (POMS).
- To determine if SELs are present in pediatric patients diagnosed with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).
- To compare the prevalence of SELs between POMS and MOGAD in a pediatric cohort.
Main Methods:
- Retrospective analysis of MRI scans from children diagnosed with POMS or MOGAD.
- Inclusion criteria required at least three research scans spaced 12 months apart and the presence of T2-lesions on the initial scan.
- Detection and quantification of slowly expanding lesions (SELs) were performed on longitudinal MRI data.
Main Results:
- Slowly expanding lesions (SELs) were identified in a significant proportion of pediatric-onset MS (POMS) participants (16 out of 19).
- A total of 70 SELs were detected in the POMS group, indicating they are an early pathological feature.
- Only one SEL was observed in the entire myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) cohort (1 out of 14), suggesting SELs are not a characteristic feature of MOGAD.
Conclusions:
- Slowly expanding lesions (SELs) represent an early pathological feature in pediatric-onset multiple sclerosis (POMS).
- The presence of SELs is rare in pediatric patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD).
- Differentiating between POMS and MOGAD may be aided by the presence or absence of SELs on serial MRI.
