Validation and Modified Application of the 2023 International Expert Consensus Criteria for Diagnosing Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease Among Children With Acquired Demyelination in Resource-Limited Regions.
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Sondhi Vishal, Desai Neelu, Lingappa Lokesh, Udani Vrajesh, Sankhyan Naveen, Gulati Sheffali, Gowda Vykuntaraju K, Saini Lokesh, Dubey Rachana, Konanki Ramesh, Goswami Jyotindra Narayan, Botre Abhijeet, Gadgil Pradnya, Passi Gouri Rao, Hegde Anaita Udwadia, Kamate Mahesh, Jain Abhishek Ravindra, Kaushik Jaya Shankar, Sharma Suvasini, Srivastava Kavita, Kulkarni Shilpa, Patel Harshkumar, Kalane Umesh, Badal Sachendra, Jha Ruchika, Deshmukh Yogeshwari, Badheka Rahul, Mohanlal Smilu, Chakrabarty Biswaroop, Jauhari Prashant, Kumar Atin, Vyas Sameer, Suthar Renu, Saini Arushi Gahlot, Bansal Arun, Tiwari Sarbesh, Khera Daisy, Meena Ankit Kumar
Аннотация
METHODS: In this multicentric retrospective study, all children aged <18 years, diagnosed or followed up by pediatric neurologists for acquired demyelination between January 1, 2017, and December 31, 2022, were included if they had undergone at least one MOG-Ab testing. The 2023 MOGAD diagnostic criteria were applied retrospectively. The pediatric neurologist's clinical diagnosis of MOGAD served as the gold standard to assess the criteria's performance using sensitivity, specificity, PPV, and NPV.
RESULTS: A total of 388 children were subjected to the 2023 MOGAD criteria. A clinical diagnosis of MOGAD was made in 190 children (true-positives), having a median (IQR) age of 7 (4.7-10) years and a median (IQR) follow-up of 48 (41-56) months; 196 children were true-negatives, not fulfilling 2023 criteria or diagnosed as MOGAD. Two children were false-positives, fulfilling criteria but diagnosed as multiple sclerosis. The 2023 MOGAD diagnostic criteria demonstrated a sensitivity of 100% (95% CI = 98.02%, 100%), specificity of 98.99% (95% CI = 96.39%, 99.82%), PPV of 98.96% (95% CI = 96.28%, 99.81%), NPV of 100% (95% CI = 98.08%, 100%), and diagnostic accuracy of 99.48% (95% CI = 98.15%, 99.94%). MOGAD criteria performed similar to MOG-Ab alone, as all MOGAD diagnoses were confined to seropositive patients.
CONCLUSION: The study demonstrates excellent performance of the 2023 MOGAD diagnostic criteria among children with acquired demyelination; however, the criteria did not enhance the diagnostic accuracy of antibody testing alone.