This study aimed to determine the seropositivity of myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) and aquaporin-4 antibodies (AQP4-Ab) and outcomes in children with acquired demyelinating syndromes (ADSs). Children (6 months–15 years) with suspected ADS were enrolled and tested for MOG-Ab and AQP4-Ab prospectively over 18 months at a tertiary care hospital in North India. Children with proven nonimmune-mediated neurological disorders were enrolled as controls. Of 79 children with suspected ADS, 66 were enrolled. Among the enrolled children with ADS, acute demyelinating encephalomyelitis (ADEM) (25) was the most common first clinical event followed by optic neuritis (ON) (20) and transverse myelitis (TM) (19; one child had ON and TM simultaneously [neuromyelitis optica spectrum disorders [NMOSDs]]), while two children had clinically isolated syndrome (CIS) apart from ON and TM. Fourteen (21.2%, confidence interval [CI] 11.3–31.1) tested positive for one antibody (12 [18.1%; 95% CI 10.5–25.5%] for MOG-Ab and 2 [3%; 95% CI 0–7.2%] for AQP4-Ab). None of the 62 controls tested positive for any antibody. The final diagnosis in those with the monophasic ADS was ADEM (21), ON (13), TM (16), and other CIS (1) while that in children with recurrent events was multiphasic disseminated encephalomyelitis (MDEM) (2), NMOSD (3), ADEM-ON (4), recurrent ON (4), and MS (2). Among those with the first event, 4/51 (7.8%; 95% CI 0.5–15.2%) were MOG-Ab positive and 2 AQP4-Ab positive, whereas 8/15 (53.3% [95% CI 28.1–78.6%]) with recurrent events (MDEM [2], ADEM-ON [4], recurrent ON [1], and recurrent TM [1]) were MOG-Ab positive. Hence, MOG-Abs are the most common antibodies detected in one in five children with pediatric ADS, especially in relapsing disease. AQP4-Abs are rare in children with ADS.

N.S.: Conceptualization of the study, facilitated the data collection, patient management, statistical analysis, and critical review of the manuscript, and review of literature. A.R.: Conceptualization of the study, facilitated the data collection, and autoantibody analysis. S.V.: Conceptualization of the study and interpretation of radiological data. J.K.S.: Conceptualization of the study, and facilitated data collection and patient management. C.B., L.S., A.G.S., R.S., J.M.: Facilitated data collection and patient management. P.M.: Facilitated data collection, patient management, reviewed the literature, and prepared the initial draft of the manuscript. J.S.: Ophthalmological testing of patients and its interpretation, and patient management. All the authors contributed to the manuscript.

Received: 22 February 2022

Accepted: 24 May 2022

Accepted Manuscript online:
26 May 2022

Article published online:
24 July 2022

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