Temporal Dynamics of MOG Antibodies in Children with Acquired Demyelinating Syndrome

Background: The spectrum of MOG-associated disorders (MOGAD) comprises monophasic diseases such as ADEM, ON and TM, and polyphasic courses of these presentations. Persistently high MOG-antibodies (MOG-IgG) are suggested to be associated with a relapsing disease course.

Objective: This article aims to assess temporal dynamics of MOG-IgG titers in children with MOGAD in correlation with clinical presentation, course, and outcome.

Methods: In this prospective multicenter study, 116 children with a first demyelinating attack and a complete data set comprising clinical and radiological findings, MOG-IgG titer at onset, clinical and serological follow-up data were included. Titer level of ≥1:160, analyzed by live cell-based assay, was classified as MOG-IgG positive.

Results: A total of 116 children with MOGAD were assigned to one of three groups according to initial presentation: opticospinal (n = 46), cerebral (n = 51), cerebral plus (n = 19). Seventy-six of 116 patients (66%) had a monophasic disease course, of whom 58/76 (76%) had a seroconversion to negative MOG-IgG titers. 20% (8/40) of patients with relapsing MOGAD had a seroconversion after at least 25 months. Seroconversion during the first and second year after disease onset showed a positive predictive value for a monophasic disease course in 100% (PPV: 1.00, 95% CI: 0.91–1.00). Clinical follow-up time was 3.3 years, serological follow-up time 3.0 years. There was no correlation between disease course and MOG-IgG titers at onset. In our cohort, no patient relapsed after (transient) seroconversion.

Conclusion: Seroconversion to MOG-IgG-negative titers (<1:160) indicated stable clinical remission in pediatric MOGAD. For an international standardized definition of seroconversion we suggest a definition by measurement of endpoint MOG-IgG titers.

Publication History

Article published online:
28 October 2021