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 Wendel, Eva Maria A1 Thonke, Helen Sophie A1 Bertolini, Annikki A1 Baumann, Matthias A1 Blaschek, Astrid A1 Merkenschlager, Andreas A1 Karenfort, Michael A1 Kornek, Barbara A1 Lechner, Christian A1 Pohl, Daniela A1 Pritsch, Martin A1 Schanda, Kathrin A1 Schimmel, Mareike A1 Thiels, Charlotte A1 Waltz, Stephan A1 Wiegand, Gert A1 Anlar, Banu A1 Barisic, Nina A1 Blank, Christian A1 Breu, Markus A1 Broser, Philip A1 Della Marina, Adela A1 Diepold, Katharina A1 Eckenweiler, Matthias A1 Eisenkölbl, Astrid A1 Freilinger, Michael A1 Gruber-Sedlmayr, Ursula A1 Hackenberg, Annette A1 Iff, Tobias A1 Knierim, Ellen A1 Koch, Johannes A1 Kutschke, Georg A1 Leiz, Steffen A1 Lischetzki, Grischa A1 Nosadini, Margherita A1 Pschibul, Alexander A1 Reiter-Fink, Edith A1 Rohrbach, Doris A1 Salandin, Michela A1 Sartori, Stefano A1 Schlump, Jan-Ulrich A1 Stoffels, Johannes A1 Strautmanis, Jurgis A1 Tibussek, Daniel A1 Tüngler, Victoria A1 Utzig, Norbert A1 Reindl, Markus A1 Rostásy, Kevin 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