Highlights
- •We found a decrease in MOG-IgG-associated disorders in children during COVID-19 related lockdown.
- •Childhood parainfectious neuroinflammatory disorders also decreased during lockdown.
- •Rates of childhood MS and AQP-4 related disease did not change during the lockdown.
Abstract
Background
Despite better characterization of the spectrum of MOG-IgG-associated disorders (MOGAD)
in children, the role of infection in its pathophysiology remains unclear. The goal
of this study was to evaluate if public health measures put in place to prevent the
spread of SARS-CoV-2 in March 2020 in Ontario (Canada) have been associated with a
change in the incidence of MOGAD and other neuroinflammatory disorders in children.
Methodology
We reviewed a single-centre cohort of children referred for a suspicion of neuroinflammatory
disorder between January 2015 and March 2021. Age, date, sex, diagnosis, MOG-IgG antibodies
status and detected pathogens at presentation were identified. Comparative statistical
analysis was performed based on diagnosis between years and seasons using Pearson's
Chi-squared test or Fisher's exact test for categorical variables and using ANOVA
or Kruskal-Wallis test for continuous variables, as appropriate. We compared the post-lockdown
period (March 17th, 2020, to March 31st, 2021) to previous calendar years (2015 to
2019) alone and to previous calendar years and the pre-lockdown 2020 period (January
1st, 2020, to March 16th, 2020). A p-value of < 0.05 was considered significant. Post-hoc
pairwise comparisons between the post-lockdown period and previous years were performed
on significant results. A false discovery rate adjustment with an adjusted p-value
(q-value) < 0.05 was computed. We hypothesized that the number of new MOGAD would
be significantly lower in the post-lockdown period compared to previous years due
to decreased regional pathogen transmission.
Results
Among 491 referred cases, we identified 415 new cases of neuroinflammatory disorder
between January 2015 and March 2021. The number of new neuroinflammatory disorder
diagnoses did not change between years. We noted significantly fewer new MOGAD diagnoses
in 2020 compared to previous years, with no MOGAD patients presenting in 2020 after
the spring lockdown (q=0.0009). In addition, there were significantly fewer parainfectious
neuroinflammatory cases (q=0.04) and pathogen detected (q=0.04) in the post-lockdown
period. The number of new multiple sclerosis (MS) and aquaporin-4 neuromyelitis optica
spectrum disorders (AQP4-NMOSD) cases remained stable despite the lockdown (q=0.185
and 0.693 respectively).
Interpretation
Enhanced population-based infection control strategies may have a role in modulating
the incidence of MOGAD and parainfectious neuroinflammatory disorders, but not MS
or AQP4-NMOSD.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Multiple Sclerosis and Related DisordersAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Seasonal variation of onset in patients with anti-aquaporin-4 antibodies and anti-myelin oligodendrocyte glycoprotein antibody.J. Neuroimmunol. 2020; 349577431
- E.U. paediatric MOG consortium consensus: part 1 - classification of clinical phenotypes of paediatric myelin oligodendrocyte glycoprotein antibody-associated disorders.Eur. J. Paediatr. Neurol. 2020; 29: 2-13
- Vagus nerve stimulation in drug-resistant epilepsies. Analysis of potential prognostic factors in a cohort of patients with long-term follow-up.Acta Neurochir. (Wien). 2012; 154: 2237-2240
- Acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis and multiple sclerosis in children.Brain. 2000; 123 (Pt): 2407-2422
- Clinical and MRI phenotype of children with MOG antibodies.Mult. Scler. 2016; 22: 174-184
- Prognostic relevance of MOG antibodies in children with an acquired demyelinating syndrome.Neurology. 2017; 89: 900-908
- How COVID-19 is changing the cold and flu season’.Nature. 2020; 588: 388-390
- Acute disseminated encephalomyelitis in childhood: epidemiologic, clinical and laboratory features.Pediatr. Infect. Dis. J. 2004; 23: 756-764
- Acute disseminated encephalomyelitis in children.Pediatrics. 2002; 110 (Pt 1)): e21
- A case of MOG antibody-positive bilateral optic neuritis and meningoganglionitis following a genital herpes simplex virus infection.Mult. Scler. Relat. Disord. 2017; 17: 148-150
- Influenza Update N° 385.World Health Organization, 2021 ((385Available at:)
- Positive predictive value of myelin oligodendrocyte glycoprotein autoantibody testing.JAMA Neurol. 2021; 78: 741-746
- Postinfectious anti-myelin oligodendrocyte glycoprotein antibody positive optic neuritis and myelitis.J. Child Neurol. 2017; 32: 996-999
Article info
Publication history
Published online: September 27, 2021
Accepted:
September 26,
2021
Received in revised form:
September 2,
2021
Received:
April 21,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
