Evolution of brain MRI lesions in paediatric myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and its relevance to disease course

Omar Abdel-Mannan, Dimitrios Champsas, Carmen Tur, Vanessa Lee, Sharmila Manivannan, Haroon Usman, Alison Skippen, Ishita Desai, Manali Chitre, Rob Forsyth, Rachel Kneen, Dipak Ram, Sithara Ramdas, Thomas Rossor, Siobhan West, Sukhvir Wright, Jacqueline Palace, Evangeline Wassmer, Cheryl Hemingway, Ming J LimKshitij Mankad, Olga Ciccarelli, Yael Hacohen

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: Lesion resolution is often observed in children with myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and asymptomatic lesions are less commonly reported in MOGAD than in multiple sclerosis (MS).

OBJECTIVE: We aimed to evaluate brain MRI changes over time in paediatric MOGAD.

METHODS: Retrospective study in eight UK paediatric neuroscience centres. Acute brain MRI and available follow-up MRIs were reviewed. Predictors for lesion dynamic were evaluated using multivariable regression and Kaplan-Meier survival analyses were used to predict risk of relapse, disability and MOG-Ab status.

RESULTS: 200 children were included (MOGAD 97; MS 103). At first MRI post attack, new symptomatic and asymptomatic lesions were seen more often in MS versus MOGAD (52/103 vs 28/97; p=0.002 and 37/103 vs 11/97; p<0.001); 83% of patients with MOGAD showed at least one lesion's resolution at first follow-up scan, and 23% had normal MRI. Only 1 patient with MS had single lesion resolution; none had normal MRI. Disappearing lesions in MOGAD were seen in 40% after the second attack, 21% after third attack and none after the fourth attack.New lesions at first follow-up scan were associated with increased likelihood of relapse (p=0.02) and persistent MOG-Ab serostatus (p=0.0016) compared with those with no new lesions. Plasma exchange was associated with increased likelihood of lesion resolution (p=0.01). Longer time from symptom onset to steroids was associated with increased likelihood of new lesions; 50% increase at 20 days (p=0.01).

CONCLUSIONS: These striking differences in lesion dynamics between MOGAD and MS suggest greater potential to repair. Early treatment with steroids and plasma exchange is associated with reduced likelihood of new lesions.

Original languageEnglish
Pages (from-to)426-433
Number of pages8
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume95
Issue number5
Early online date18 Nov 2023
DOIs
Publication statusPublished - 12 Apr 2024

Bibliographical note

Copyright © Author(s), 2023. This article has been accepted for publication in the Journal of Neurology, Neurosurgery & Psychiatry following peer review, and the Version of Record can be accessed online at: https://doi.org/10.1136/jnnp-2023-332542. Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International license (CC-BY-NC 4.0) https://creativecommons.org/licenses/by-nc/4.0/

Keywords

  • PAEDIATRIC NEUROLOGY
  • MYELIN
  • MRI
  • NEUROIMMUNOLOGY
  • MULTIPLE SCLEROSIS

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