A Closer Look at MOGAD and Pediatric Multiple Sclerosis

Why It Matters

Accurate, early differentiation between pediatric MS and MOGAD enables timely disease‑modifying treatment, limiting long‑term neurological damage and improving lifelong outcomes.

Key Takeaways

• Pediatric MS presents with relapsing‑remitting attacks and early MRI lesions.
• MOGAD should be screened in children with ADEM‑like MRI patterns.
• Updated 2025 McDonald criteria add optic nerve as fifth region.
• Central vein sign and rim lesions improve diagnostic confidence in children.
• Early antibody testing guides treatment and prevents secondary progressive disability.

Summary

The podcast from Johns Hopkins clinicians examines pediatric multiple sclerosis (MS) and myelin oligodendrocyte glycoprotein antibody‑associated disease (MOGAD), outlining typical presentations, imaging hallmarks, and diagnostic pathways.

Key points include the spectrum of acute neurologic signs—encephalopathy, Lhermitte’s phenomenon, optic neuritis—and MRI patterns such as periventricular, juxtacortical, spinal, and optic‑nerve lesions. The speakers highlight the 2025 McDonald criteria, which now count optic‑nerve involvement as a fifth topographic region and incorporate advanced biomarkers like the central‑vein sign and paramagnetic rim lesions. They stress that children with ADEM‑like, extensive T2‑bright lesions should be tested for MOG antibodies, given a roughly 50% positivity rate under age 12.

Illustrative cases feature a 5‑year‑old with diffuse encephalopathy, a 14‑year‑old experiencing Lhermitte’s sign, and an 8‑year‑old with unilateral optic neuritis, each demonstrating characteristic bright‑signal lesions on T2‑weighted MRI. One adolescent’s scan revealed “black holes” (T1 hypointense lesions) despite a first clinical attack, underscoring subclinical disease accumulation. The discussion also covers radiologically isolated syndrome and the role of oligoclonal bands or CSF free‑light‑chain analysis in confirming MS.

For clinicians, the take‑away is that applying the updated criteria, leveraging advanced imaging biomarkers, and promptly testing for MOG antibodies can accelerate accurate diagnosis, guide disease‑modifying therapy, and reduce the risk of secondary progressive disability in pediatric patients.

Original Description

Watch pediatric neurologists Brenda Banwell and Haiwen Chen discuss diagnosing and treating myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and pediatric multiple sclerosis. #researchsaveschildren #MOGAD #PEDSMS