To comparatively evaluate the socioeconomic, demographic, and serologic features associated with pediatric patients diagnosed with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) or multiple sclerosis (MS).

Past studies have examined the clinical differences between pediatric MS and MOGAD patients; however, there is little-to-no data regarding their socioeconomic and demographic differences. Evaluating these differences increases understanding of underlying pathobiology, helps to identify differentiating risk factors, and aids in timely and accurate diagnosis.  

Using our pediatric research database, we identified a total of 25 MOGAD and 60 MS patient records. Patients were excluded if they were not primarily evaluated in our pediatric neuroimmunology clinic or were >18 years at the time of diagnosis. Subsequently, data from 21 MOGAD and 51 MS patient records, meeting inclusion criteria, were analyzed.

MOGAD patients manifested with neurological symptoms at a younger age (7.0 ± 4.1 vs 15.0 ± 2.0 years, P<0.001) and were less likely to have serologic evidence of Epstein-Barr nuclear antigen IgG (40% vs 100%, P<0.001) compared to MS patients. MOGAD patients were more likely to exhibit an infectious prodrome (52% vs. 14%, P<0.001) and have been breastfed (80% vs. 44%, P<0.05). Pediatric MS patients demonstrated decreased daycare attendance (37% vs. 88%, p<0.05) and a lower household income ($60,700 ± 2,800 vs. $67,500 ± 1,600, P<0.03) compared to MOGAD patients. There was no significant difference regarding peri or post-natal exposures, family history of autoimmune disease, or 25-hydroxyvitamin D level.

Children with MOGAD are younger, come from higher-earning households, and are more likely to have been breastfed, attend daycare, and experience infectious prodromes compared to their MS counterparts. These features provide insight into the pathogenesis of MOGAD and may be used to differentiate those children with MOGAD vs MS early in the diagnostic evaluation.