Abstract Details

Title Oligoclonal Bands in Pediatric MOG Antibody-associated Disease: Prognostic Biomarker or Evidence of Distinctive Phenotype?

Topic Autoimmune Neurology

Presentation(s) S6 - Autoimmune Neurology: NMOSD and MOGAD (1:48 PM-2:00 PM)

Poster/Presentation
Number 005

Objective Evaluate significance of cerebrospinal fluid (CSF) oligoclonal bands (OCBs) at symptom onset in pediatric MOG antibody-associated disease (MOGAD) to assess predictive value for relapsing disease or even a distinct phenotype.

Background Up to 38% of pediatric MOGAD cases experience relapse, prompting the search for predictive markers such as CSF-OCBs and the possibility of a distinct MOGAD phenotype.

Design/Methods Children meeting 2023 MOGAD diagnostic criteria with confirmed MOG-IgG seropositivity, lumbar puncture at presentation, and ≥12 months follow-up were included. Clinical, laboratory, and radiographic data was collected on relapse frequency, presence of OCBS, initial phenotype, and MRI findings. Group comparisons used Fisher’s exact test for categorical and Kruskal-Wallis test for continuous variables (significance: p<0.05).

Results Fifty-nine patients (53% female, median age 11 years) were included, with eighteen patients (31%) who experienced relapsing disease. Thirteen (22%) had CSF-OCBs. OCB-positive patients experienced more relapses (p<0.001; H=9.83), were more likely to have persistent MOG-IgG >1 year after presentation (p=0.01; OR 0.18; RR 0.48), and remained on immunosuppressive therapy (p=0.01; OR 0.14; RR 0.24). Seven patients had severe relapsing MOGAD requiring additional long-term immunotherapy on final follow-up, three of which had positive OCBs (43%). Initial clinical phenotype and MRI lesion location did not differ, though OCB-positive patients had more frequent perineural enhancement (p=0.04; OR 0.14; RR 0.39). No significant differences were observed in EDSS at 12 months, CSF MOG-IgG (25 tested), CSF pleocytosis, or CSF white blood cell count.

Conclusions MOGAD with positive OCBs was associated with increased relapse risk, persistent MOG-IgG titers, and ongoing immunosuppressive therapy suggesting a more severe presentation requiring increased additional therapy. This may suggest OCBs as a prognostic marker for relapsing MOGAD or indicate heightened disease activity reflecting a distinct relapsing phenotype, however further investigation is needed.

Authors/Disclosures
Sydney M. Talmi, BA, ScM PRESENTER	Ms. Talmi has nothing to disclose.
Shermila Pia, MD	Dr. Pia has nothing to disclose.
Jonathan Santoro, MD (Department of Neurology, Children's Hospital Los Angeles)	Dr. Santoro has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Santoro has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Cycle Pharma. Dr. Santoro has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Dianthus. Dr. Santoro has received personal compensation in the range of $500-$4,999 for serving as a Consultant for National Down Syndrome Society.
Vaishnavi L. Vaidyanathan, MD (Home)	Dr. Vaidyanathan has nothing to disclose.

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