Myelin Oligodendrocyte Glycoprotein (MOG) Antibodies in the Cerebrospinal Fluid of Pediatric Patients With MOG Antibody-Associated Disease: Insights From an Asian Multicenter Cohort.

BACKGROUND

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an inflammatory demyelinating disorder in children. While serum myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) is a recognized biomarker, the role of cerebrospinal fluid (CSF) MOG-IgG remains unclear, particularly in Asian pediatric populations. This study aimed to assess the diagnostic and prognostic significance of CSF MOG-IgG in pediatric MOGAD patients in Asia.

METHODS

In this retrospective multicenter study, 63 pediatric MOGAD patients were identified based on clinical and radiological features and underwent paired serum and CSF MOG-IgG testing between 2000 and 2023 at two Korean institutions using a flow-cytometry-based assay.

RESULTS

MOG-IgG was detected in both serum and CSF in 44 (70%) patients, serum only in 17 (27%), and CSF only in 2 (3%). Most patients (65.1%) had a monophasic course, and both CSF-only cases remained monophasic during follow-up. CSF-positive patients exhibited significantly higher CSF white blood cell counts (P = 0.011) and more favorable long-term outcomes, as indicated by lower final Expanded Disability Status Scale scores (P < 0.001).

CONCLUSIONS

This study highlights the clinical characteristics of CSF MOG-IgG in Asian pediatric MOGAD patients, suggesting a possible monophasic course in CSF-only cases and potential ethnic variations, though confirmation in larger prospective cohorts is warranted.