Comparative immunopathology and clinical features of MOGAD and AQP4-IgG NMOSD in children: A scoping review

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a distinct immune-mediated demyelinating central nervous system disorder, frequently presenting as optic neuritis in children and adolescents. Conversely, aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) is an astrocytopathy characterized by more severe relapses and greater residual visual impairment. This scoping review, conducted according to PRISMA-ScR and JBI methodology, mapped evidence from 23 studies identified across PubMed and Scopus over the last decade. The objective was to examine the epidemiology, clinical presentation, imaging, serological findings, therapeutic strategies, and visual outcomes of these conditions in pediatric populations. Results indicate that pediatric MOGAD-associated optic neuritis often presents with optic disc swelling and bilateral anterior optic nerve involvement with perineural enhancement on MRI, typically resulting in reversible visual loss. The 2023 MOGAD diagnostic criteria show high performance in children. In contrast, AQP4-associated optic neuromyelitis more commonly involves the posterior optic nerve and chiasm, leading to poorer visual outcomes. Regarding treatment, maintenance intravenous immunoglobulin (IVIG) reduces relapse risk in selected MOGAD cases, while B-cell-depleting regimens are primarily used for relapse prevention in AQP4-positive NMOSD. In conclusion, pediatric optic neuritis in MOGAD and AQP4-associated optic neuromyelitis are distinct phenotypes with differing pathobiology and therapeutic requirements. Early serological confirmation and individualized immunotherapy are crucial for preventing relapses and preserving functional vision in pediatric patients.