Early Predictors of Outcome in Pediatric Acquired Demyelinating Syndromes: A Retrospective Study Stratified by Final...

Area of Science:

• Neurology
• Pediatrics
• Immunology

Background:

• Pediatric acquired demyelinating syndromes (ADSs) are diverse, including multiple sclerosis (MS), MOG antibody-associated disease (MOGAD), and neuromyelitis optica spectrum disorder (NMOSD).
• Accurate diagnosis and early outcome prediction are vital for managing pediatric ADSs, which have varied prognoses.
• Real-world data often involves initial diagnostic uncertainty, necessitating analysis of predictors based on final diagnoses.

Purpose of the Study:

• To identify early predictors of long-term outcomes in pediatric patients diagnosed with acquired demyelinating syndromes (ADSs).
• To compare the clinical trajectories and prognoses of different subtypes of pediatric ADSs, including MOGAD, MS, and NMOSD.

Main Methods:

• Retrospective analysis of 30 pediatric patients with ADSs, assessing clinical, radiological, CSF, antibody, and neurophysiological data.
• Evaluation of treatment strategies, including disease-modifying therapies (DMTs) and acute immunotherapy.
• Longitudinal assessment of outcomes over 3 years, including EDSS scores, MRI changes, and clinical status.

Main Results:

• MOGAD, MS, and NMOSD were the most common final diagnoses, with MOGAD showing a more favorable course.
• Early immunotherapy (90% of patients) and baseline factors like ≥3 brain lesions (76.7%) were prevalent.
• EDSS progression correlated with DMT use, MRI lesion type, CSF findings, antibody status, and evoked potentials; neurocognitive function predicted 3-year outcomes.

Conclusions:

• Early immunotherapy and baseline instrumental findings are critical predictors for pediatric ADSs outcomes.
• MS and NMOSD are associated with higher long-term disability compared to MOGAD.
• A prompt and comprehensive diagnostic approach is essential for improving the prognosis of pediatric ADSs.