Evolution of brain MRI lesions in paediatric myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and its relevance to disease course.
Evolution of brain MRI lesions in paediatric myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and its relevance to disease course.
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儿科髓鞘少突胶质细胞糖蛋白抗体相关疾病 (MOGAD) 脑 MRI 病变的演变及其与病程的相关性。
DOI：
10.1136/jnnp-2023-332542
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Abdel-Mannan O
中科院分区：
文献类型：
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作者：
Abdel-Mannan O
Backgroundlesion决议经常观察到在儿童髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD），和无症状的病变较少报道MOGAD比多发性硬化症（MS）。我们的目的是评估随着时间的推移，在儿科MOGAD.MethodsRetrospective研究在英国8个儿科神经科学中心的脑MRI变化。对急性脑MRI和可用的随访MRI进行了审查。采用多变量回归分析评估病变动态预测因子，Kaplan-Meier生存分析用于预测复发风险、残疾和MOG-Ab状态。结果纳入200例儿童（MOGAD 97例; MS 103例）。在发作后首次MRI时，MS与MOGAD相比更常观察到新的症状性和无症状性病变（52/103 vs 28/97; p=0.002和37/103 vs 11/97; p<0.001）; 83%的MOGAD患者在首次随访扫描时显示至少一处病变消退，23%的MRI正常。仅1例MS患者的单个病变消退;无正常MRI。第二次发作后MOGAD病灶消失率为40%，第三次发作后为21%，第四次发作后为0。与无新病灶者相比，首次随访扫描时新病灶与复发可能性增加（p=0.02）和持续MOG-Ab血清状态（p=0.0016）相关。血浆置换与病变消退的可能性增加相关（p=0.01）。较长的时间从症状发作到类固醇与新病变的可能性增加; 50%增加在20天（p=0.01）。早期使用类固醇和血浆置换治疗与新病变的可能性降低相关。
BackgroundLesion resolution is often observed in children with myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and asymptomatic lesions are less commonly reported in MOGAD than in multiple sclerosis (MS).ObjectiveWe aimed to evaluate brain MRI changes over time in paediatric MOGAD.MethodsRetrospective study in eight UK paediatric neuroscience centres. Acute brain MRI and available follow-up MRIs were reviewed. Predictors for lesion dynamic were evaluated using multivariable regression and Kaplan-Meier survival analyses were used to predict risk of relapse, disability and MOG-Ab status.Results200 children were included (MOGAD 97; MS 103). At first MRI post attack, new symptomatic and asymptomatic lesions were seen more often in MS versus MOGAD (52/103 vs 28/97; p=0.002 and 37/103 vs 11/97; p<0.001); 83% of patients with MOGAD showed at least one lesion’s resolution at first follow‐up scan, and 23% had normal MRI. Only 1 patient with MS had single lesion resolution; none had normal MRI. Disappearing lesions in MOGAD were seen in 40% after the second attack, 21% after third attack and none after the fourth attack.New lesions at first follow-up scan were associated with increased likelihood of relapse (p=0.02) and persistent MOG-Ab serostatus (p=0.0016) compared with those with no new lesions. Plasma exchange was associated with increased likelihood of lesion resolution (p=0.01). Longer time from symptom onset to steroids was associated with increased likelihood of new lesions; 50% increase at 20 days (p=0.01).ConclusionsThese striking differences in lesion dynamics between MOGAD and MS suggest greater potential to repair. Early treatment with steroids and plasma exchange is associated with reduced likelihood of new lesions.