Our study aims to characterize clinical presentations, radiological findings, management and treatment outcomes of pediatric patients presenting with myelin oligodendrocyte glycoprotein (MOG) associated longitudinally extensive transverse myelitis (LETM).

Myelin oligodendrocyte associated antibody disorder (MOGAD) is a demyelinating disorder of the central nervous system that demonstrates a wide phenotype, particularly in the pediatric population. Longitudinally extensive transverse myelitis (LETM)-defined as lesions extending ≥ 3 vertebral segments- is a distinct presenting feature of MOGAD.

Retrospective review of medical records of pediatric patients (age < 18 years), with a diagnosis of MOGAD associated LETM, between the years 2020 and 2025, at the Children’s Hospital of Pittsburgh.

A total of 17 patients diagnosed with MOGAD associated LETM were identified. Mean age of presentation was 9 years, with a slight male predominance. Common presenting symptoms included headaches, lower extremity weakness, and gait instability. MRI analyses revealed the highest frequency of lesions within cervical and thoracic cord regions, with a minority involving the lumbar cord. Post-contrast enhancement was seen in a small minority of patients- three with lesional enhancement and one with leptomeningeal enhancement. All patients had concurrent supratentorial brain lesions. Everyone received treatment with high dose steroids, followed by a steroid taper, while seven patients were also treated with IVIG or plasmapheresis. Upon longitudinal follow up, one patient had relapsed; rest showed complete resolution of radiologic findings with minimal to no neurological deficits.

MOGAD associated LETM in children is characterized by prominent neurologic deficits, a predilection to cervical and thoracic cord, excellent steroid responsiveness, and a low relapse rate. Post-contrast enhancement, longer segments of spine involvement, were shown to indicate a worse presentation with high MOG antibody titers, requiring immunotherapies. Overall, although LETM in MOGAD presents with significant initial disability, long term outcomes are favorable with appropriate treatment and monitoring.