Abstract
Background and Objectives Acute disseminated encephalomyelitis (ADEM) is the most common phenotype in pediatric myelin oligodendrocyte glycoprotein (MOG) antibody–associated disease. A previous study demonstrated impaired brain growth in ADEM. However, the effect of MOG antibodies on brain growth remains unknown. Here, we performed brain volume analyses in MOG-positive and MOG-negative ADEM at onset and over time.
Methods In this observational cohort study, we included a total of 62 MRI scans from 24 patients with ADEM (54.2% female; median age 5 years), of which 16 (66.7%) were MOG positive. Patients were compared with healthy controls from the NIH pediatric MRI data repository and a matched local cohort. Mixed-effect models were applied to assess group differences and other relevant factors, including relapses.
Results At baseline and before any steroid treatment, patients with ADEM, irrespective of MOG antibody status, showed reduced brain volume compared with matched controls (median [interquartile range] 1,741.9 cm3 [1,645.1–1,805.2] vs 1,810.4 cm3 [1,786.5–1,836.2]). Longitudinal analysis revealed reduced brain growth for both MOG-positive and MOG-negative patients with ADEM. However, MOG-negative patients showed a stronger reduction (−138.3 cm3 [95% CI −193.6 to −82.9]) than MOG-positive patients (−50.0 cm3 [−126.5 to −5.2]), independent of age, sex, and treatment. Relapsing patients (all MOG positive) showed additional brain volume loss (−15.8 cm3 [−68.9 to 37.3]).
Discussion Patients with ADEM exhibit brain volume loss and failure of age-expected brain growth. Importantly, MOG-negative status was associated with a more pronounced brain volume loss compared with MOG-positive patients.
Glossary
- 3D=
- three dimensional;
- ADEM=
- acute disseminated encephalomyelitis;
- ADS=
- acquired demyelinating syndrome;
- EDSS=
- Expanded Disability Status Scale;
- GM=
- gray matter;
- IVIG=
- IV immunoglobulin;
- MDEM=
- multiphasic ADEM;
- MOG=
- myelin oligodendrocyte glycoprotein;
- MOGAD=
- MOG antibody–associated disease;
- MS=
- multiple sclerosis;
- NfL=
- neurofilament light chain;
- OND=
- other neurologic disorders;
- POMS=
- pediatric-onset MS;
- WBV=
- whole-brain volume;
- WM=
- white matter
Footnotes
Go to Neurology.org/NN for full disclosures. Funding information is provided at the end of the article.
Submitted and externally peer reviewed. The handling editor was Editor Josep O. Dalmau, MD, PhD, FAAN.
- Received May 4, 2022.
- Accepted in final form October 10, 2022.
- Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
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