Analysis of risk factors for relapse in pediatric MOG antibody-associated disease: a single-center retrospective cohort study

Objective Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an immune-mediated demyelinating disorder of the central nervous system. It has a higher incidence in children than in adults, carries a relatively high risk of relapse with unclear mechanisms, and significantly impacts patient prognosis. This study aimed to investigate the clinical characteristics of MOGAD and identify independent risk factors for relapse, to provide a basis for early intervention and individualized treatment. Methods A total of 108 children diagnosed with MOGAD at the Children’s Hospital of Nanjing Medical University between January 2020 and June 2024 were retrospectively enrolled. Clinical, laboratory, and radiological data were collected. Univariate analysis and multivariate logistic regression models were used to screen for risk factors associated with relapse. Results The median follow-up time was 37 months, with a relapse rate of 30.6%. The proportion of patients presenting with seizures (54.5% vs. 20.0%, p < 0.001) and limb weakness (27.3% vs. 9.3%, p = 0.018) at onset was significantly higher in the relapse group compared to the monophasic group. The most common initial clinical phenotype was acute disseminated encephalomyelitis (ADEM) type (38.9%), while optic neuritis (ON) type became predominant at relapse (48.9%). Multivariate analysis identified seizures (OR = 7.155, 95% CI: 2.265–22.604, p < 0.001) and limb weakness (OR = 5.157, 95% CI: 1.322–20.117, p = 0.018) as independent risk factors for relapse, whereas a normal brain MRI (OR = 0.186, 95% CI: 0.035–0.985, p = 0.048) was a protective factor. The relapse group had a higher proportion of patients with high serum MOG antibody titers (≥1:100) (54.5% vs. 32.0%, p = 0.027) and elevated cerebrospinal fluid cell counts (>30 × 10 6 /L) (66.7% vs. 44.0%, p = 0.03). Patients receiving oral corticosteroids for ≥6 months during the remission phase had a significantly lower relapse rate (42.4% vs. 65.3%, p = 0.026). Conclusion In pediatric MOGAD, the ADEM phenotype is most common at onset. Seizures and limb weakness at initial presentation are independent risk factors for relapse in children with MOGAD, while a normal brain MRI suggests a lower relapse risk. Prolonging the corticosteroid treatment course during remission (≥6 months) may help reduce the relapse risk. Enhanced follow-up and individualized treatment should be considered for children with high-risk factors. These findings may help clinicians identify high-risk patients and tailor long-term immunosuppressive therapy.