Silent New Brain MRI Lesions in Children with MOG‐Antibody Associated Disease

Anti‐myelin oligodendrocyte glycoprotein immunoglobulin G (MOG‐IgG) antibodies are associated clinically with either a monophasic or relapsing disease course. We investigated the frequency and clinical importance of acquired asymptomatic brain magnetic resonance imaging (MRI) lesions in a prospective incident cohort of 74 MOG‐IgG positive children with serial MRI scans over a median of 5 years from presentation. Silent new lesions were detected in 14% of MOG‐IgG positive participants, most commonly within the first months post‐onset, with a positive predictive value for clinically relapsing disease of only 20%. Detection of asymptomatic lesions alone need not prompt initiation of chronic immunotherapy. ANN NEUROL 2021;89:408–413