Abstract Details

Title Dynamic MRI Lesion Evolution in Pediatric Myelin-Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD)

Topic Multiple Sclerosis

Presentation(s) S27 - MS Neuroimaging (2:00 PM-2:12 PM)

Poster/Presentation
Number 006

Background In Myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), both radiological lag with worsening of the MRI during clinical recovery and dramatic lesion resolutions have been reported. There are few studies studying lesion evolution in pediatric MOGAD.

Objective

To evaluate MRI lesion evolution over time and correlate with patients’ clinical state.

Design/Methods

Clinical and paraclinical features were reviewed in children (<18yr) with MOGAD from five UK tertiary paediatric neurosciences centres between 2014-2022.

Results

558 MRI scans from 152 patients and 295 attacks were available for analysis. Median age at presentation was 6.1yrs (IQR 4.0-10.6), 64 (42.1%) were male and 41 (26.9%) were of non-White ethnicities. At final follow-up (median period 4.42 years, IQR: 2.28-7.74) 57/152 (37.5%) had a relapsing disease course. Median number of relapses were 3, IQR (2-4). At onset, brain lesions were seen in 84/152 (55.2%), spine in 31/152 (20.3%), optic nerve in 48/152 (31.5%) and gadolinium-enhancing lesions in 34/42 (80.9%). MRI was normal in 8/152(5.2%) at first scan, of which 4/8 had new asymptomatic lesions within 1 month. New asymptomatic lesions (> 1 month) following first clinical event were seen in 17/152 (11.1%) with persistent contrast enhancement in 8/49 (16.3%). Of 89 patients who had follow-up imaging following first attack, 16 relapsed within 6 months, complete lesion resolution was reported in 26/89 (17.5%) (22 monophasic, 4 relapsing) following 1st acute attack, 7/35(20%) after 2nd acute attack, and 1/16 (6.2%) following 3rd acute attack and none following further relapses. Partial resolution of MRI lesions was seen in 19/51 (37.2%) monophasic patients and 9/39(23%) relapsing patients after the first follow-up scan (p>0.5).

Conclusions

Lesions in paediatric MOGAD are dynamic and timing of MRI scanning may reveal different regional involvement. Unlike in MS, a significant number of MOGAD patients will have complete lesion resolution at first follow-up, although this repair ability is reduced in relapsing patients.

Authors/Disclosures
Omar Abdel-Mannan, MD (Great Ormond Street Hospital) PRESENTER	Dr. Abdel-Mannan has nothing to disclose.
Dimitrios Champsas (Institue of Neurology, UCL)	No disclosure on file
	No disclosure on file
Kshitij Mankad	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Evangeline Wassmer, MD (Birmingham Children's Hospital)	Dr. Wassmer has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Biogen. The institution of Dr. Wassmer has received research support from Birmingham Children's Hospital Charity Research Foundation.
Cheryl Hemingway	No disclosure on file
	No disclosure on file
	No disclosure on file
Olga Ciccarelli, MD, PhD, FRCP (UCL Institute of Neurology)	Prof. Ciccarelli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Prof. Ciccarelli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Prof. Ciccarelli has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Merck. Prof. Ciccarelli has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NEUROLOGY Journal.
Yael Hacohen, MBBS (Great Ormond Street Hospital)	Dr. Hacohen has nothing to disclose.