Neuropediatrics 2025; 56(S 01): S1-S24
DOI: 10.1055/s-0045-1812154
Neuroinflammatory Disorders

Diagnostic Value of MOGAD Criteria in the Context of Low MOG-IgG Antibody Titer in Children

Authors

  • E.-M. Wendel

    1   Olgahospital, Klinikum Stuttgart, Neuropädiatrie, Stuttgart, Germany

  • A. Zengin

    2   Department of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey

  • A. Panzer

    3   Kinderklinik Datteln, Universität Witten/Herdecke, Radiologie, Datteln, Germany

  • I. El Naggar

    4   Kinderklinik Datteln, Universität Witten/Herdecke, Neuropädiatrie, Datteln, Germany

  • S. Saracoglu

    3   Kinderklinik Datteln, Universität Witten/Herdecke, Radiologie, Datteln, Germany

  • S. Cramer

    4   Kinderklinik Datteln, Universität Witten/Herdecke, Neuropädiatrie, Datteln, Germany

  • M. Karenfort

    5   Universitätsklinikum Düsseldorf, Neuropädiatrie, Düsseldorf, Germany

  • K. Schanda

    6   Medizinische Universität Innsbruck, Klinische Neurologie, Innsbruck, Austria

  • M. Schimmel

    7   Medizinische Universität Augsburg, Neuropädiatrie, Augsburg, Germany

  • M. Reindl

    6   Medizinische Universität Innsbruck, Klinische Neurologie, Innsbruck, Austria

  • K. Rostasy

    4   Kinderklinik Datteln, Universität Witten/Herdecke, Neuropädiatrie, Datteln, Germany
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Background/Purpose: Diagnostic criteria for MOGAD were updated in 2023, with additional required clinical and radiological criteria in patients with low-positive MOG-IgG-antibody (ab) titer. The objective was to investigate the diagnostic value of low positive MOG-IgG-ab titer together with MRI findings.

Methods: Children with a first acquired demyelinating syndrome of the CNS (ADS) were included in our BIOMARKER study since 2009 from different international centers. We analyzed children from this retrospective multicenter cohort. Inclusion criteria encompassed age <18 years, MOG-IgG-ab titer at first event, data from first clinical/radiological presentation, and follow-up of >12 months with final diagnosis. Serum samples were analyzed by live cell-based assay, and titer levels of ≥1:160 are defined as MOG-IgG-ab positive.

Results: A total of 1,630 children with a first ADS included in the ongoing BIOMARKER study were tested for MOG-IgG-ab. Three hundred thirty-two patients tested positive for MOG-IgG-ab (range: >1:160–81920). In 100 children, a low-MOG-IgG-ab titer ranging from 1:160 to 1:320 was detected (F:M = 51:49; mean age 9 years). Fifty patients had a titer of 1:160 and 50 patients a titer of 1:320. Seventy-two percent (n = 36/100) with a titer of 1:160 had radiological evidence of MOGAD, thus fulfilled the MOGAD criteria, compared to 96% (n = 48/100) with a titer of 1:320. In 16/100 patients (16%), an alternative diagnosis was found. Thirteen out of 16 patients were diagnosed with multiple sclerosis (n = 11 with 1:160, n = 2 with 1:320). None of them fulfilled the radiologic MOGAD criteria. One patient had an episode of acute flaccid myelitis (1:160), one patient had meningoencephalitis not fulfilling the MOGAD criteria (OIND; 1:160), and one patient had cerebral lesions due to liver problems (OND; 1:160).

Conclusion: Our findings support the clinical value of the recently proposed diagnostic criteria with MOGAD in children with low-range MOG titer. MOGAD MRI criteria are shown to have a very high diagnostic value in association with low MOG-ab titer, especially in the differentiation from MS.



Publication History

Article published online:
26 September 2025

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