1/6 of the children with MS are anti-MOG+

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Prospective characterization of children positive for anti-MOG antibodies meeting Multiple Sclerosis diagnostic criteria

https://n.neurology.org/content/92/15_S ... 2.abstract

Abstract

Objective: To characterize the clinical features and outcome of children meeting diagnostic criteria for multiple sclerosis (MS) who were seropositive for antibodies against myelin oligodendrocyte glycoprotein (MOGabs).

Background: A minority of subjects meeting the MS diagnostic criteria are MOGabs seropositive (MOG+). Whether these patients exhibit clinical features distinct from typical MS is unclear.

Design/Methods: We assessed the presence of MOGabs in 66 children (median [IQR] age at onset 13.97 [IQR 10.88–15.06] years) diagnosed with MS according to 2010 international diagnostic criteria. Clinical, serological and imaging features were prospectively assessed for a median of 7 years from presentation, and compared between MOG+ and MOG− children using descriptive statistics.

Results: At clinical onset, 11/66 (17%) children were MOG+. Seropositive patients were younger (p<0.0001) than seronegative patients, and all presented at age <11 years. The presenting phenotype was optic neuritis (ON) and/or transverse myelitis (TM) for 80% of seropositive versus 41% of the seronegative patients (p =0.019). Brain MRIs at onset were atypical for MS in 9 MOG+ (3 without brain lesions, 3 with diffuse bilateral pattern and 3 with minimal lesions) and 4 MOG− patients (p<0.0001). Oligoclonal bands (OCBs) were detected in 2/8 (25%) MOG+ and in 20/36 (83%) MOG− patients evaluated (p =0.0027). None of the MOG+ patients showed contrast enhancement on baseline MRI, thus none met 2010 McDonald criteria at onset; 2 MOG+ patients met the 2017 criteria due to the presence of OCBs. Of 11 MOG+ patients, 10 developed new brain lesions, 1 developed new spinal cord lesions, and 7 experienced clinical relapses (in almost all cases ON or TM). At last follow-up, total T2 lesion volume in MOG+ patients was significantly smaller compared to MOG− ones (p<0.0001).

Conclusions: While meeting MS diagnostic criteria, children seropositive for MOGabs exhibit clinical and MRI features distinguishing them from MOG-negative typical relapsing MS patients.