Clinical and radiological characteristics of MOG antibody-associated disease (MOGAD): a comparative study between pediatric and adult cohorts.

Abstract

Objective: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a distinct inflammatory demyelinating disorder As being first national study of pediatric and adult Turkish MOGAD patients so we aimed to report the clinical presentations, radiological findings, and relapse characteristics between pediatric and adult patients with MOGAD.

, materials and methods: In this retrospective study, 26 patients (10 pediatric [≤ 17 years] and 16 adult [> 17 years]) who tested positive for MOG antibodies were included. Demographic data, precipitating factors, Expanded Disability Status Scale (EDSS) scores, cerebrospinal fluid (CSF) findings, and magnetic resonance imaging (MRI) features were analyzed.

Results: The mean age was 10.8 years for children and 32.5 years for adults. Precipitating factors, primarily upper respiratory infections, were more frequent in children (70% vs. 12.5%). Pediatric patients predominantly presented with polysymptomatic onset, including pyramidal signs (60%) and encephalopathy (30%), whereas adults most commonly presented with optic neuritis (62.5%). Although adults had higher mean EDSS scores during relapse compared to children (4.31 vs. 3.55), final follow-up EDSS scores were low for both groups (0.78 vs. 0.5). Relapses were recorded only in the adult group (mean rate 1.93). Radiologically, children showed significantly higher rates of brainstem (34.6% vs. 7.6%) and cortical involvement. Spinal MRI revealed the "H-sign" in both groups, but conus involvement was more prevalent in children (75% vs. 7.6%).

Conclusion: MOGAD exhibits age-dependent clinical and radiological phenotypes. While pediatric cases often follow a post-infectious, polysymptomatic, and monophasic course, adult cases frequently present as optic neuritis with a higher tendency for relapse. Despite significant acute disability, functional recovery at the last visit was favorable in both populations over a mean follow-up of 24.1 ± 8.2 months in children and 33.6 ± 36.7 months in adults.