Journal of Pediatric Neurology 2019; 17(01): 031-037
DOI: 10.1055/s-0037-1608795
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Clinical Course and Treatment in MOG Antibody Seropositive Children: A Case Series

Grace Y. Kim
1   Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, Massachusetts, United States
,
Shrishti Saxena
2   Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, United States
,
Tanuja Chitnis
1   Partners Pediatric Multiple Sclerosis Center, Massachusetts General Hospital, Boston, Massachusetts, United States
2   Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, United States
› Author Affiliations
Further Information

Publication History

18 July 2017

16 October 2017

Publication Date:
22 November 2017 (online)

Abstract

Myelin oligodendrocyte glycoprotein (MOG) antibodies have been associated with pediatric demyelinating diseases. The clinical course in a patient with MOG positivity is variable but not well-characterized. Here, we describe the clinical course and treatment in MOG antibody positive demyelinating diseases in our pediatric population. This case series is of 13 patients who tested MOG antibody positive: two relapsing remitting multiple sclerosis (RR-MS), seven acute demyelinating encephalomyelitis (ADEM) or ADEM-optic neuritis (ADEM-ON), two clinically isolated syndrome (CIS), and two neuromyelitis optica (NMO). These patients appear to have more relapses, requiring more medications including IV steroids and IVIG. These patients are also more likely to start on disease modifying therapy (DMT) earlier, and β-interferon appears to not prevent relapses. MOG antibody positivity could provide as a marker for predicting frequent relapses in RR-MS and NMO patients, allowing for therapeutic intervention with earlier DMT.

Funding

This work is supported by the Guthy Jackson Charitable Foundation (T.C.).


 
  • References

  • 1 Rostásy K, Mader S, Hennes EM. , et al. Persisting myelin oligodendrocyte glycoprotein antibodies in aquaporin-4 antibody negative pediatric neuromyelitis optica. Mult Scler 2013; 19 (08) 1052-1059
  • 2 Rostasy K, Mader S, Schanda K. , et al. Anti-myelin oligodendrocyte glycoprotein antibodies in pediatric patients with optic neuritis. Arch Neurol 2012; 69 (06) 752-756
  • 3 Huppke P, Rostasy K, Karenfort M. , et al. Acute disseminated encephalomyelitis followed by recurrent or monophasic optic neuritis in pediatric patients. Mult Scler 2013; 19 (07) 941-946
  • 4 McLaughlin KA, Chitnis T, Newcombe J. , et al. Age-dependent B cell autoimmunity to a myelin surface antigen in pediatric multiple sclerosis. J Immunol 2009; 183 (06) 4067-4076
  • 5 Ramanathan S, Dale RC, Brilot F. Anti-MOG antibody: The history, clinical phenotype, and pathogenicity of a serum biomarker for demyelination. Autoimmun Rev 2016; 15 (04) 307-324
  • 6 van Pelt ED, Wong YY, Ketelslegers IA, Hamann D, Hintzen RQ. Neuromyelitis optica spectrum disorders: comparison of clinical and magnetic resonance imaging characteristics of AQP4-IgG versus MOG-IgG seropositive cases in the Netherlands. Eur J Neurol 2016; 23 (03) 580-587
  • 7 Spadaro M, Gerdes LA, Krumbholz M. , et al. Autoantibodies to MOG in a distinct subgroup of adult multiple sclerosis. Neurol Neuroimmunol Neuroinflamm 2016; 3 (05) e257
  • 8 Fernandez-Carbonell C, Vargas-Lowy D, Musallam A. , et al. Clinical and MRI phenotype of children with MOG antibodies. Mult Scler 2016; 22 (02) 174-184
  • 9 Krupp LB, Tardieu M, Amato MP. , et al; International Pediatric Multiple Sclerosis Study Group. International Pediatric Multiple Sclerosis Study Group criteria for pediatric multiple sclerosis and immune-mediated central nervous system demyelinating disorders: revisions to the 2007 definitions. Mult Scler 2013; 19 (10) 1261-1267
  • 10 Chitnis T, Ness J, Krupp L. , et al. Clinical features of neuromyelitis optica in children: US Network of Pediatric MS Centers report. Neurology 2016; 86 (03) 245-252
  • 11 Thulasirajah S, Pohl D, Davila-Acosta J, Venkateswaran S. Myelin Oligodendrocyte Glycoprotein-Associated Pediatric Central Nervous System Demyelination: Clinical Course, Neuroimaging Findings, and Response to Therapy. Neuropediatrics 2016; 47 (04) 245-252
  • 12 Chitnis T, Graves J, Weinstock-Guttman B. , et al; U.S. Network of Pediatric MS Centers. Distinct effects of obesity and puberty on risk and age at onset of pediatric MS. Ann Clin Transl Neurol 2016; 3 (12) 897-907
  • 13 Jarius S, Ruprecht K, Kleiter I. , et al; in cooperation with the Neuromyelitis Optica Study Group (NEMOS). MOG-IgG in NMO and related disorders: a multicenter study of 50 patients. Part 2: Epidemiology, clinical presentation, radiological and laboratory features, treatment responses, and long-term outcome. J Neuroinflammation 2016; 13 (01) 280
  • 14 Krumbholz M, Faber H, Steinmeyer F. , et al. Interferon-beta increases BAFF levels in multiple sclerosis: implications for B cell autoimmunity. Brain 2008; 131 (Pt 6): 1455-1463
  • 15 Kothur K, Wienholt L, Tantsis EM. , et al. B Cell, Th17, and Neutrophil Related Cerebrospinal Fluid Cytokine/Chemokines Are Elevated in MOG Antibody Associated Demyelination. PLoS One 2016; 11 (02) e0149411