Clinical, Radiologic, and Optical Coherence Tomographic Features of Pediatric Acute Disseminated Encephalomyelitis: Comparison of Myelin Oligodendrocyte Glycoprotein Antibody–Positive and –Negative Cases

Background

Acute disseminated encephalomyelitis (ADEM) typically presents as a monophasic demyelinating disorder associated with multifocal neurological symptoms and encephalopathy in children. Myelin oligodendrocyte glycoprotein antibody (MOG-IgG) is detected in a subset of patients and may be linked to recurrence risk. This study evaluated the clinical, radiologic, and optic coherence tomographic (OCT) features of children with ADEM based on MOG-IgG serostatus.

Methods

We retrospectively reviewed pediatric ADEM cases with MOG-IgG testing at initial presentation between 2017 and 2024.

Results

Of 38 children with ADEM, 27 (71.1%) were MOG-IgG positive at initial presentation. Reported decreased vision and optic nerve involvement on imaging were more frequent in MOG-IgG-positive children (18.5% vs 0.0% and 36.4% vs 0.0%, respectively), although these differences did not reach statistical significance. Hospitalization duration and need for intensive care unit stay were similar between groups. On follow-up imaging, complete lesion resolution was significantly more common in MOG-IgG-negative children (75.5% vs 22.2%, P = 0.014). Among 30 children with geater than or equal to six months of follow-up, good recovery (modified Rankin scale score <2) occurred in 65.5% and relapse in 23.1%, with no significant differences between groups. OCT revealed a trend toward increased frequency of retinal nerve fiber layer thinning in MOG-IgG-positive children (50.0% vs 0.0%).

Conclusions

In this single-center study, MOG-IgG-positive ADEM is associated with greater optic nerve involvement, whereas MOG-IgG-negative ADEM showed more frequent complete lesion resolution. These findings support incorporating MOG-IgG testing, dedicated orbital imaging, and OCT into the diagnostic and follow-up evaluation of pediatric ADEM.