Clinical Features of Children With MOG-IgG Who Fulfill Criteria of Multiple Sclerosis and Overlapping Disorders

Area of Science:

• Pediatric neurology
• Neuroimmunology
• Demyelinating diseases

Background:

• Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and multiple sclerosis (MS) are distinct demyelinating disorders.
• Distinguishing between MOGAD and MS in children can be challenging, particularly at disease onset.
• Understanding the clinical course and treatment response in pediatric MOG-IgG patients meeting MS criteria is crucial.

Purpose of the Study:

• To characterize the clinical features of pediatric MOG-IgG patients who fulfill the 2017 McDonald criteria for MS.
• To evaluate the response to disease-modifying treatments (DMTs) in this cohort.
• To report the long-term outcomes for children with MOG-IgG and MS.

Main Methods:

• Prospective observational study of children (<18 years) with suspected acquired demyelinating syndrome (ADS).
• Inclusion criteria: MOG-IgG positive serum or CSF, meeting MS criteria, and ≥1 year follow-up.
• MOG-IgG testing performed using live cell-based assays.

Main Results:

• Eight pediatric patients (4% of MOG-IgG ADS cohort) met MS criteria.
• Clinical presentations varied, including typical MS and overlapping MOGAD-MS features.
• Five of 7 patients were Epstein-Barr virus seropositive; all 8 showed persistent radiologic activity requiring DMT.
• 88% of patients ultimately required high-efficacy DMT.

Conclusions:

• A small but significant proportion of pediatric MOG-IgG patients meet MS diagnostic criteria.
• The clinical and radiological spectrum is broad, ranging from MS to MOGAD-MS.
• Effective management often necessitates aggressive, high-efficacy DMTs in these complex cases.