Significance of brain lesions associated with optic neuritis in pediatric myelin oligodendrocyte glycoprotein antibody-associated disease.

BACKGROUND

Optic neuritis (ON) is a common presenting core clinical attack type in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and can be associated with brain lesions at presentation. The significance of these brain lesions and their contribution to disease course, however, are poorly understood.

METHODS

Multi-center retrospective chart review of clinical, laboratory, and radiologic data of pediatric MOGAD patients who presented with an ON phenotype.

RESULTS

35 episodes of ON, including 29 new onset MOGAD attacks and 6 ON relapses, were analyzed among 32 total pediatric MOGAD patients (median age 12 years [range 3-18]; 69 % female). 20/35 (57 %) presented with ON without brain lesions and 15/35 (43 %) presented with ON and brain lesions. 11/15 (73 %) episodes of ON and brain lesions did not have ADEM. Clinically, 7/11 (64 %) were asymptomatic from the brain lesions; 2/11 (18 %) experienced seizures, and 2/11 (18 %) experienced focal neurologic deficits. Lesion morphology and distribution varied among episodes, with 7/11 (64 %) demonstrating small, non-specific, and non-confluent lesions on MRI. Patients in all groups at 3 months after presentation had a good outcome with a modified Rankin Score (mRS) of 0-2.

CONCLUSIONS

Most brain lesions in pediatric MOGAD ON patients are clinically silent, small, and non-specific. Patients with ON and brain lesions did not have worse mRS outcomes compared to patients with ON without brain lesions. Further investigation of paraclinical data and more sensitive outcome measures will help elucidate pathophysiologic differences between these phenotypes and help guide prognostication.