Carmen Yea

Diagnostic criteria for anti-myelin oligodendrocyte glycoprotein (MOG) antibody-associated diseases (MOGADs) were published in 2023, but debate regarding optimal therapeutic strategies for pediatric MOGAD exists. The aim of this study was to evaluate treatment approaches and preferred diagnostic investigations for pediatric MOGAD among neurologists. A survey questionnaire focused on pediatric MOGAD treatment was launched through the Practice Current Section of Neurology® Clinical Practice in April-October 2024. Responses from neurologists were solicited through advertisements on American Academy of Neurology (AAN) social media platforms, on the AAN website, and in print editions of Neurology®, as well as through QR codes shared at professional neurologic meetings. The questionnaire included 12 questions evaluating clinical decision making after a first and second neuroinflammatory episode, in a child testing positive for MOG-IgG antibody. Demographic questions were included. Responses were evaluated using descriptive statistics. A comparative analysis was conducted between those who self-identified as neuroimmunologists (NIs) and those who did not. A total of 346 neurologists completed the survey (52.3% of general neurologists, 32.1% of NIs, and 15.6% in other neurology fields). Of all respondents, 90.5% chose to send serum MOG-IgG antibody after the first event (59.7% serum, 36.4% CSF + serum). For acute treatment, 84.1% chose to give a 3-5-day course of high-dose IV steroids. Approaches to steroid tapering varied, with 33.0% choosing a 2-4-week taper, 27.2% choosing a 7-12-week taper, and 21% not offering a steroid taper. 56.6% of non-NIs chose to initiate maintenance therapy after the first episode while only 18.9% of NIs chose to do so. After the second episode, 98.3% of all respondents recommended starting maintenance therapy, with rituximab (RTX) (37.1%) being the most frequently chosen agent, followed by monthly IV immunoglobulin (IVIG) (25.6%) and azathioprine (17.1%). NIs selected monthly IVIG (50%) over RTX (27.3%). The duration of treatment in relapsing cases varied: 42.9% elected to maintain treatment for 2 years or less and 35.3% for more than 2 years, and 21.8% chose to continue treatment indefinitely. The survey demonstrated substantial variability in management decisions related to MOGAD among neurologists, reflecting current gaps in knowledge about therapies for MOGAD. Future efforts are needed to improve the uptake of knowledge and ensure that current guidelines are effectively translated into clinical practice.

Background and Objectives: Neurological involvement associated with SARS-CoV-2 infection is increasingly recognized. However, the specific characteristics and prevalence in pediatric patients remain unclear. The objective of this study was to describe the neurological involvement in a multinational cohort of hospitalized pediatric patients with SARS-CoV-2.Methods: This was a multicenter observational study of children n = 103), encephalopathy (n = 28), and seizures (n = 30) were the most reported. Neurological signs/symptoms were significantly associated with ICU admission (OR: 1.71, 95% CI: 1.15–2.55; p = 0.008), satisfaction of MIS-C criteria (OR: 3.71, 95% CI: 2.46–5.59; p < 0.001), fever during hospitalization (OR: 2.15, 95% CI: 1.46–3.15; p < 0.001), and gastrointestinal involvement (OR: 2.31, 95% CI: 1.58–3.40; p < 0.001). Non-headache neurological manifestations were significantly associated with ICU admission (OR: 1.92, 95% CI: 1.08–3.42; p = 0.026), underlying neurological disorders (OR: 2.98, 95% CI: 1.49–5.97, p = 0.002), and a history of fever prior to hospital admission (OR: 2.76, 95% CI: 1.58–4.82; p < 0.001).Discussion: In this study, approximately 21% of hospitalized children with SARS-CoV-2 infection had neurological signs/symptoms. Future studies should focus on pathogenesis and long-term outcomes in these children.