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

医学 疾病 多发性硬化 髓鞘少突胶质细胞糖蛋白 少突胶质细胞 髓鞘 抗体 病理 脱髓鞘病 免疫学 中枢神经系统 内科学 实验性自身免疫性脑脊髓炎
作者
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 Lim,Kshitij Mankad,Olga Ciccarelli,Yael Hacohen
出处
期刊:Journal of Neurology, Neurosurgery, and Psychiatry [BMJ]
卷期号:: jnnp-332542 被引量:3
标识
DOI:10.1136/jnnp-2023-332542
摘要

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 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). Conclusions 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.
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