Clinico-investigational profile, relapse predictors and outcomes of pediatric patients with anti-myelin oligodendrocyte associated disorders: An experience from tertiary centre

Background: The data on relapse and outcome predictors in pediatric anti-Myelin oligodendrocyte antibody associated diseases (MOGAD) is poorly delineated in the literature. Methods: We performed a retrospective study of the clinico-investigational profile of pediatric patients (age<18 years) who met the international diagnostic criteria for MOGAD, 2023 and assessed the predictors for clinical relapse and equated the trajectory of outcomes over a long-term follow-up. Results: We recruited 46 children (males=24, 52.2 %), with a median age at onset 11(8 to 16) years and a median duration of 15 (IQR 6-45) days. The core demyelinating events observed were optic neuritis (n = 19, 41.3 %), acute disseminating encephalomyelitis (n = 13, 28.3 %), transverse myelitis (n = 10, 21.7 %), cerebral deficits (n = 3, 6.5 %), brainstem/cerebellar syndrome (n = 2, 4.3 %), cerebral cortical encephalitis (n = 2, 4.3 %) and atypical presentations (n = 1, 2.2 %). Prevalence of ADEM was significantly higher among children <10 years (p = 0.046). At a median follow-up of 28 months, ON was significantly associated with relapse, with an odds ratio (OR) of 5.175 (95 % CI 1.286-20.824, p = 0.021), unlike other core demyelinating events. In 11 cases (23.9 %) referral diagnosis was not MOGAD. Neither the degree of serum anti-MOG antibody positivity [strong vs weak: OR 1.506 (0.407 to 5.578), p = 0.480] nor its persistence [OR 0.955 (0.201 to 4.538), p = 0.953] were identified to be relapse predictors. There was a significant improvement in modified Rankin scale (mRS) scores between presentation, intermediate and at last follow-up (p < 0.001). Conclusions: The study highlights the predictors for relapse, and presents a follow-up data of >2 years on pediatric MOGAD. It reveals optic neuritis as a risk factor for relapse. The study emphasises the importance of a broad range of antibody testing including anti-MOG in patients with suspected autoimmune encephalitis.