{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:05:00Z","timestamp":1756339500962,"version":"3.44.0"},"reference-count":13,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,1,2]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>While advancements in the classification of acquired demyelinating syndromes have significantly benefited children with this condition, some cases present with overlapping features, posing diagnostic challenges. We describe an Asian girl of early childhood age with acute visual loss. Examination revealed right optic neuritis, left optic nerve atrophy and demyelinating lesions in the juxtacortical brain parenchyma. Anti-myelin oligodendrocyte glycoprotein antibody was elevated, while oligoclonal bands and anti-aquaporin 4 antibody were negative. The patient met the 2023 International Diagnostic Criteria for Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) and, concurrently, potentially fulfilled the 2013 International Pediatric Multiple Sclerosis Study Group criteria for paediatric multiple sclerosis (MS). The primary diagnosis was MOGAD, with paediatric MS considered as a possibility. Corticosteroid treatment improved vision, with no recurrence over 6 months without disease-modifying therapy. Both optic fundi showed atrophy 3 months after the acute phase, but the visual acuity was normal in both eyes, further raising the possibility of MOGAD over paediatric MS. This case highlights the diagnostic complexities in paediatric acute demyelinating syndromes, demonstrating potential overlap between MOGAD and MS diagnoses in children.<\/jats:p>","DOI":"10.1136\/bcr-2024-263624","type":"journal-article","created":{"date-parts":[[2025,1,19]],"date-time":"2025-01-19T20:50:42Z","timestamp":1737319842000},"page":"e263624","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Myelin oligodendrocyte glycoprotein antibody-associated disease\/paediatric multiple sclerosis overlap: a diagnostic conundrum"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4594-9545","authenticated-orcid":false,"given":"Taro","family":"Higuchi","sequence":"first","affiliation":[{"name":"Center for Postgraduate Education and Training, National Center for Child Health and Development, Setagaya-ku, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6384-0205","authenticated-orcid":false,"given":"Itaru","family":"Hayakawa","sequence":"additional","affiliation":[{"name":"Neurology, National Center for Child Health and Development, Setagaya-ku, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroshi","family":"Sakuma","sequence":"additional","affiliation":[{"name":"Department of Brain & Neurosciences, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuichi","family":"Abe","sequence":"additional","affiliation":[{"name":"Neurology, National Center for Child Health and Development, Setagaya-ku, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,19]]},"reference":[{"key":"2025082708102340000_18.1.e263624.1","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1212\/WNL.0000000000004117","article-title":"Diagnostic algorithm for relapsing acquired demyelinating syndromes in children","volume":"89","author":"Hacohen","year":"2017","journal-title":"Neurology (ECronicon)"},{"key":"2025082708102340000_18.1.e263624.2","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(22)00431-8"},{"key":"2025082708102340000_18.1.e263624.3","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1177\/13524585231156736","article-title":"Epidemiological and clinical characteristics of myelin oligodendrocyte glycoprotein antibody-associated disease in a nationwide survey","volume":"29","author":"Nakamura","year":"2023","journal-title":"Mult 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children with an acquired demyelinating syndrome: an illustrative case report","volume":"17","author":"Midaglia","year":"2023","journal-title":"Front Neurosci"},{"key":"2025082708102340000_18.1.e263624.8","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.neurad.2019.06.001","article-title":"MRI features of demyelinating disease associated with anti-MOG antibodies in adults","volume":"46","author":"Den\u00e8ve","year":"2019","journal-title":"J Neuroradiol"},{"key":"2025082708102340000_18.1.e263624.9","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000207805","article-title":"Adding the Optic Nerve in Multiple Sclerosis Diagnostic Criteria: A Longitudinal, Prospective, Multicenter Study","volume":"102","author":"Vidal-Jordana","year":"2024","journal-title":"Neurology (ECronicon)"},{"key":"2025082708102340000_18.1.e263624.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.msard.2022.103525"},{"key":"2025082708102340000_18.1.e263624.11","doi-asserted-by":"crossref","DOI":"10.3389\/fimmu.2023.1029124","article-title":"Retinal structural and microvascular changes in myelin oligodendrocyte glycoprotein antibody disease and neuromyelitis optica spectrum disorder: An OCT\/OCTA study","volume":"14","author":"Lang","year":"2023","journal-title":"Front Immunol"},{"key":"2025082708102340000_18.1.e263624.12","doi-asserted-by":"crossref","first-page":"12069","DOI":"10.1038\/s41598-024-62704-w","article-title":"Variability of relationship between inner-retinal structural changes and visual dysfunction in optic neuropathy","volume":"14","author":"Joo","year":"2024","journal-title":"Sci Rep"},{"key":"2025082708102340000_18.1.e263624.13","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1002\/ana.26440","article-title":"Longitudinal Retinal Changes in MOGAD","volume":"92","author":"Oertel","year":"2022","journal-title":"Ann Neurol"}],"container-title":["BMJ Case 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