Testing for anti-MOG antibodies is highly recommended for relapsing inflammatory demyelinating central nervous system diseases in pediatric patients, in order to define early an adequate long-term treatment. After the 3rd episode, anti-MOG antibody testing was performed and higher titer was detected. Throughout these three episodes, serological tests associated with autoimmune diseases, viral markers, anti-aquaporin-4 antibodies, and cerebrospinal fluid oligoclonal bands were negative, with the immunoglobulin G index in the normal range. Despite regular interferon β-1a injection after steroid tapering, she developed a 3rd episode presenting as a right ON. Her vision improved dramatically after steroid therapy however, 3 months after the 1st episode, she developed acute encephalopathy with extensive newly developed ADEM-like lesions and resolution of previous hyperintensities. Initially, she suffered from left ON with subclinical brain lesions including magnetic resonance imaging hyperintensities in the bilateral frontal subcortical white matter, the left thalamus, and the right cerebral peduncle. Here, we report the case of a 6-year-old Korean girl with recurrent steroid-responsive optic neuritis (ON) and an episode of acute disseminated encephalomyelitis (ADEM) with a high MOG antibody titer. Any medication started would be discussed in full detail if needed.Myelin oligodendrocyte glycoprotein (MOG) antibody-associated diseases are reported to have distinct pathogenic mechanisms, clinical courses, and therapeutic implications in comparison to other acquired demyelinating syndromes. ![]() These types of medicine are used to control your child’s immune system and to damp down inflammation. Medicines that may be used include azathioprine, mycophenolate mofetil or in some cases rituximab. If a child continues to have relapses, then maintenance treatment may be required to prevent further relapses. Both these treatments will be explained in full detail if needed.įor many children, after an initial attack, it can be difficult to predict if further attacks will happen so it is not always beneficial to start a long term treatment. In rare cases, if high dose steroids do not improve your child’s symptoms, other treatment may need to be considered, such as intravenous immunoglobulins (IVIGs) or plasma exchange. Steroids do not change your child’s risk of a relapse. Steroids have both short and long term side effects so your child will not usually stay on them for a long time. These side effects will be discussed with you in more detail at the time. Your child may then start an oral course of steroid tablets and you will be given a plan of how to reduce these gradually.Ĭhildren usually respond very well to steroid treatment during this acute phase. ![]() This will usually be given at high dose for three to five days via a cannula into a vein. Intravenous steroid treatment is often used to treat the acute symptoms of demyelination to try to reduce the inflammation that has occurred. How is MOG antibody demyelination diagnosed? These relapses could happen either months or even years apart and therefore it can be difficult to predict. arm weakness (if higher up the spinal cord)Ĭhildren may also have symptoms such as nausea, vomiting, ataxia (unsteadiness) and extreme lethargy or tiredness.įor many children that have a MOG antibody demyelination episode, it will be a one off and they have no further attack of symptoms (relapse). However, some children may be at risk of further relapses.Symptoms come on quickly and can vary depending on where the inflammation has occurred in the spine. Transverse myelitis is inflammation of the spinal cord. Optic neuritis is demyelination of the optic nerve and can affect one or both eyes. Some children may initially present with acute disseminated encephalomyelitis (ADEM) which is an inflammatory condition that mainly affects the brain and others may have signs of optic neuritis or transverse myelitis. Symptoms of MOG antibody demyelination can be variable from person to person and can range from mild to severe depending on which parts of the brain are affected.
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