Evolution of brain MRI lesions in paediatric myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and its relevance to disease course.

BACKGROUND: Lesion 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). OBJECTIVE: We aimed to evaluate brain MRI changes over time in paediatric MOGAD. METHODS: Retrospective 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. RESULTS: 200 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). CONCLUSIONS: These 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.

A comparative study of clinical profile and symptom control in overweight and normal weight school-age children with mild persistent asthma.

OBJECTIVES: To find out the proportion of children with poor symptom control in overweight/obese and normal weight children with mild persistent asthma and to know the sociodemographic and clinical correlates of poor symptom control in them. MATERIALS AND METHODS: Children aged 6 to 12 years with mild persistent asthma with BMI Z score for age and sex more than +1 Z score on WHO BMI Z score chart for age and sex formed the cases. Age- and sex-matched asthmatics with BMI Z score for age and sex between -2 Z and +1 Z score formed the controls. FEV1, FEV1/FVC were measured in both groups using Care Fusion Jaeger spirometer. Symptom control was assessed by ACT score. Statistical analysis was done using SPSS version 19 and Vassarstats. RESULTS: The proportion of children with poor control was 19.1% in the overweight/obese group and 23.4% in the normal weight group. There was no significant correlation between BMI and symptom control as assessed by the ACT score. Overweight/obese children with good control showed a slightly lower FEV1/FVC ratio and higher median eosinophil count compared to children with normal weight. Gastroesophageal reflux and allergic rhinitis were more commonly seen in overweight/obese children. In the poor control group, FEV1, FEV1/FVC, and median eosinophil counts were not significantly different between overweight/obese and normal weight group but were less when compared to good control group. CONCLUSION: The proportion of poor symptom control was not high in overweight/obese asthmatic children compared to normal weight asthmatic children. No significant risk factors for poor symptom control could be identified in our study for either of the groups.

Choroid Osteoma in Schimmelpenning-Feuerstein-Mims Syndrome.

BACKGROUND: Schimmelpenning syndrome is a multisystem disorder. CASE CHARACTERISTICS: A term female neonate with sebaceous nevi of the face had choroid osteoma of the right eye. OBSERVATION: At one month of age, the infant was observed to have choroidal neovascularization that was successfully treated with laser photo-coagulation and anti-VEGF. MESSAGE: Choroid osteoma and neovascularization are rare associations of Schimmelpenning syndrome, and should be screened for and managed early.