RT Journal Article SR Electronic T1 Temporal Dynamics of MOG Antibodies in Children With Acquired Demyelinating Syndrome JF Neurology - Neuroimmunology Neuroinflammation JO Neurol Neuroimmunol Neuroinflamm FD Lippincott Williams & Wilkins SP e200035 DO 10.1212/NXI.0000000000200035 VO 9 IS 6 A1 Eva Maria Wendel A1 Helen Sophie Thonke A1 Annikki Bertolini A1 Matthias Baumann A1 Astrid Blaschek A1 Andreas Merkenschlager A1 Michael Karenfort A1 Barbara Kornek A1 Christian Lechner A1 Daniela Pohl A1 Martin Pritsch A1 Kathrin Schanda A1 Mareike Schimmel A1 Charlotte Thiels A1 Stephan Waltz A1 Gert Wiegand A1 Banu Anlar A1 Nina Barisic A1 Christian Blank A1 Markus Breu A1 Philip Broser A1 Adela Della Marina A1 Katharina Diepold A1 Matthias Eckenweiler A1 Astrid Eisenkölbl A1 Michael Freilinger A1 Ursula Gruber-Sedlmayr A1 Annette Hackenberg A1 Tobias Iff A1 Ellen Knierim A1 Johannes Koch A1 Georg Kutschke A1 Steffen Leiz A1 Grischa Lischetzki A1 Margherita Nosadini A1 Alexander Pschibul A1 Edith Reiter-Fink A1 Doris Rohrbach A1 Michela Salandin A1 Stefano Sartori A1 Jan-Ulrich Schlump A1 Johannes Stoffels A1 Jurgis Strautmanis A1 Daniel Tibussek A1 Victoria Tüngler A1 Norbert Utzig A1 Markus Reindl A1 Kevin Rostásy A1 , YR 2022 UL http://nn.neurology.org/content/9/6/e200035.abstract AB Background and Objective The spectrum of myelin oligodendrocyte glycoprotein (MOG) antibody–associated disorder (MOGAD) comprises monophasic diseases such as acute disseminated encephalomyelitis (ADEM), optic neuritis (ON), and transverse myelitis and relapsing courses of these presentations. Persistently high MOG antibodies (MOG immunoglobulin G [IgG]) are found in patients with a relapsing disease course. Prognostic factors to determine the clinical course of children with a first MOGAD are still lacking. The objective of the study is to assess the clinical and laboratory prognostic parameters for a risk of relapse and the temporal dynamics of MOG‐IgG titers in children with MOGAD in correlation with clinical presentation and disease course.Methods In this prospective multicenter hospital-based study, children with a first demyelinating attack and complete data set comprising clinical and radiologic findings, MOG-IgG titer at onset, and clinical and serologic follow-up data were included. Serum samples were analyzed by live cell-based assay, and a titer level of ≥1:160 was classified as MOG-IgG–positive.Results One hundred sixteen children (f:m = 57:59) with MOGAD were included and initially diagnosed with ADEM (n = 59), unilateral ON (n = 12), bilateral ON (n = 16), myelitis (n = 6), neuromyelitis optica spectrum disorder (n = 8) or encephalitis (n = 6). The median follow-up time was 3 years in monophasic and 5 years in relapsing patients. There was no significant association between disease course and MOG-IgG titers at onset, sex, age at presentation, or clinical phenotype. Seroconversion to MOG-IgG–negative within 2 years of the initial event showed a significant risk reduction for a relapsing disease course. Forty-two/one hundred sixteen patients (monophasic n = 26, relapsing n = 16) had serial MOG-IgG testing in years 1 and 2 after the initial event. In contrast to relapsing patients, monophasic patients showed a significant decrease of MOG-IgG titers during the first and second years, often with seroconversion to negative titers. During the follow-up, MOG-IgG titers were persistently higher in relapsing than in monophasic patients. Decrease in MOG-IgG of ≥3 dilution steps after the first and second years was shown to be associated with a decreased risk of relapses. In our cohort, no patient experienced a relapse after seroconversion to MOG-IgG–negative.Discussion In this study, patients with declining MOG-IgG titers, particularly those with seroconversion to MOG-IgG–negative, are shown to have a significantly reduced relapse risk.ADEM=acute disseminated encephalomyelitis; ADEMON=acute disseminated encephalomyelitis, followed by optic neuritis; ADS=acute/acquired demyelinating syndrome; DMT=disease-modifying therapy; EDSS=expanded disability status scale; FU=follow-up; IgG=immunoglobulin G; IQR=interquartile range; IVIG=intravenous immunoglobulin; MDEM=multiphasic acute disseminated encephalomyelitis; MOG=myelin oligodendrocyte glycoprotein; MOGAD=MOG-IgG associated disorder; NMOSD=neuromyelitis optica spectrum disorder; OCBs=oligoclonal bands; ON rec=recurrent optic neuritis; ON=optic neuritis; PLEX=plasma exchange; TM=transverse myelitis