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


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 vs MOGAD (52/103 vs 28/97; p=0.002 and 37/103 vs 11/97; p<0.001); 83% of MOGAD patients showed at least one lesion’s resolution at 1st follow‐up scan, and 23% had normal MRI. Only 1 MS patient had single lesion resolution; none had normal MRI. Disappearing lesions in MOGAD were seen in 40% after the 2nd attack, 21% after 3rd attack and none after the 4th attack. New lesions at 1st follow-up scan were associated with increased likelihood of relapse (p=0.02) and persistent MOG-Ab serostatus (p=0.0016) compared to 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 and Relevance: 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.

Publication DOI: https://doi.org/10.1136/jnnp-2023-332542
Divisions: College of Health & Life Sciences > Aston Pharmacy School
College of Health & Life Sciences > School of Biosciences
Additional Information: 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/
Publication ISSN: 1468-330X
Last Modified: 22 Jul 2024 07:33
Date Deposited: 29 Nov 2023 16:35
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Related URLs: https://jnnp.bm ... nnp-2023-332542 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2023-11-18
Published Online Date: 2023-11-18
Accepted Date: 2023-10-23
Authors: Abdel-Mannan, Omar
Champsas, Dimitrios
Tur, Carmen
Lee, Vanessa
Manivannan, Sharmila
Usman, Haroon
Skippen, Alison
Desai, Ishita
Chitre, Manali
Forsyth, Rob
Kneen, Rachel
Ram, Dipak
Ramdas, Sithara
Rossor, Thomas
West, Siobhan
Wright, Sukhvir (ORCID Profile 0000-0002-5464-3779)
Palace, Jacqueline
Wassmer, Evangeline
Hemingway, Cheryl
Lim, Ming J
Mankad, Kshitij
Ciccarelli, Olga
Hacohen, Yael


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