Challenges and Research Priorities for Pediatric MOGAD: Kelsey Poisson, MD

WATCH TIME: 3 minutes

"I think that finding ways to do that risk stratification would be really helpful… especially in a pediatric-specific population."

Myelin oligodendrocyte glycoprotein antibody disease (MOGAD), often misdiagnosed as multiple sclerosis (MS), is a recently identified demyelinating disorder with a diverse clinical spectrum. Recent advancements in the detection of MOG antibodies have contributed significantly to characterizing the MOGAD spectrum; however, the increased use of MOG antibody testing has raised the risk of false positives, further emphasizing the importance of cautious interpretation.

The MOGAD field has made several strides in recent years, capped off by a formal diagnostic criterion published by leading experts in 2023. According to the proposed criteria, MOGAD is typically associated with acute disseminated encephalomyelitis, optic neuritis, or transverse myelitis, and is less commonly associated with cerebral cortical encephalitis, brainstem presentations, or cerebellar presentations. MOGAD manifests differently in children compared with adults, both in terms of clinical presentation, disease course, and treatment response.

In an interview with NeurologyLive®, neuroimmunologist Kelsey Poisson, MD, discussed some of research needs for pediatric patients with MOGAD. Poisson, a neurologist at Nationwide Children’s Hospital, emphasized the need for improved risk stratification at the first attack to identify which children are at higher risk of relapse and may benefit from short-term maintenance immunosuppression. She also discussed the questions around steroid treatment, particularly regarding optimal duration, tapering strategies, and the potential negative impacts of prolonged steroid use on mood and self-esteem in children and adolescents. Furthermore, she pointed to the underexplored long-term neurobehavioral and neurocognitive effects of MOGAD, such as ADHD, executive dysfunction, and behavioral dysregulation.