Researchers compared the clinical and radiographic characteristics of pediatric- and adult-onset neuromyelitis optica spectrum disorder (NMOSD) and found that pediatric patients were more likely to have a successful response to treatment, as published in the Journal of Child Neurology. They also found that pediatric patients were less likely to develop disabilities than their adult counterparts.

“[NMOSD] has been increasingly recognized in children who demonstrate patterns of clinical involvement beyond the traditional boundaries of the optic pathways and spinal cord,” the authors explained.

“This retrospective chart review, using the same cohort from our earlier study, aims to characterize and compare the demographic, clinical/paraclinical, laboratory, and radiographic features of pediatric-onset [NMOSD] in comparison to adult disease.”

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Read more about NMOSD prognosis

The research team reviewed the charts of 43 cases of aquaporin-4 (AQP4)-immunoglobin G-positive NMOSD (12 pediatric-onset and 31 adult-onset). The results highlight both the common features of pediatric disease and adult disease and certain differences between them, such as more frequent involvement of the brainstem and diencephalon, a better treatment response during attacks, and reduced accumulated disability in the pediatric patients.

Previously, inflammation of the conus medullaris has been reported in adult-onset NMOSD, and in this study, the authors also found such involvement in 2 of the pediatric cases.

Most infectious cases of NMOSD have an absence of AQP4 antibodies; however, the authors identified pediatric cases with prior urinary tract infections and 3 cases with immunoglobulin M to Mycoplasma pneumoniae at the initial presentation. They, therefore, recommend further investigation into the possibility of infection as a trigger for pediatric-onset NMOSD.


Tarhan B, Rempe T, Rahman S, et al. A comparison of pediatric- and adult-onset aquaporin-4 immunoglobulin g–positive neuromyelitis optica spectrum disorder: a review of clinical and radiographic characteristics. J Child Neurol. Published online June 7, 2022. doi:10.1177/08830738221103085