Leptomeningeal Enhancement in Pediatric Anti-Myelin Oligodendrocyte Glycoprotein Antibody Disease, Multiple Sclerosis, and Neuromyelitis Optica Spectrum Disorder

Abstract

Background: Anti-myelin oligodendrocyte glycoprotein (MOG) antibody disease (MOGAD) is a type of acquired demyelinating disease that is distinct from multiple sclerosis (MS) and aquaporin-4 antibody neuromyelitis optica spectrum disorder (AQP4-NMOSD). Leptomeningeal enhancement (LME) has been reported in children and adults with MOGAD, and in adults with MS and AQP4-NMOSD, but less is known about LME in pediatric-onset MS (POMS) and pediatric AQP4-NMOSD. Here we compare the rates of LME in children with MOGAD, POMS, and AQP4-NMOSD.

Methods: A retrospective chart review was performed in patients with MOGAD, POMS, and AQP4-NMOSD who presented to our institution. Clinical characteristics, imaging features, and relapsing data were included. Descriptive statistics were used, including chi-square or Fischer exact test, to compare proportions. The Benjamini-Hochberg procedure was used to correct for multiple comparisons.

Results: A total of 42 children were included: 16 with POMS, six with AQP4-NMOSD, and 20 with MOGAD. Brain LME was only observed in the MOGAD group (six of 20 = 30%) when compared with zero (0%) POMS and AQP4-NMOSD (P = 0.012). Relapsing disease occurred in nine of 20 (45%), but LME did not associate with relapse.

Conclusions: LME is only observed in pediatric MOGAD and not in POMS or pediatric AQP4-NMOSD. LME did not predict relapses in MOGAD. Further work is needed to determine the clinical significance of LME in pediatric MOGAD.

Keywords: MOG; MOGAD; Multiple sclerosis; Myelin oligodendrocyte glycoprotein-associated disorder; NMO; NMOSD; Neuromyelitis optica spectrum disorder; Pediatric.