• 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 Lim, Kshitij Mankad, Olga Ciccarelli, Yael Hacohen, and UK-Childhood Neuroinflammatory Disease Network.
• Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK.
• J. Neurol. Neurosurg. Psychiatr. 2024 Apr 12; 95 (5): 426433426-433.

BackgroundLesion 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).ObjectiveWe aimed to evaluate brain MRI changes over time in paediatric MOGAD.MethodsRetrospective 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.Results200 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).ConclusionsThese 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.© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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