Emerging Neurologic Autoimmune Disorders (MOGAD) in the PICU
Aug 10, 2025
A young girl presents with seizures and respiratory failure, prompting a deep dive into Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. The discussion highlights the complexities of diagnosing this challenging autoimmune disorder in pediatric care. Experts emphasize the critical need for early immunosuppressive therapy and a multidisciplinary approach. Through real case analysis, listeners gain insights into effective management strategies, including airway control and collaboration with specialists, enhancing patient outcomes in acute neuroimmunological emergencies.
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Case: Rapid Deterioration After Initial Discharge
A previously healthy seven-year-old developed seizures, behavioral changes, and respiratory failure after a first seizure and brief hospitalization.
She returned with status epilepticus and was admitted to the ICU for neurologic and respiratory support.
insights INSIGHT
MOGAD Targets Oligodendrocytes
MOGAD is an antibody-mediated demyelinating disorder affecting oligodendrocytes and myelin in the CNS.
Clinical phenotypes overlap with ADEM and neuromyelitis optica, often causing optic neuritis, spinal cord, or cerebral involvement.
insights INSIGHT
Anti‑MOG Is Clinically Significant
FLAMES is a recognized syndrome: focal lesions and seizures associated with anti-MOG.
Anti-MOG antibodies appear in a substantial fraction of pediatric demyelinating syndromes and AQP4-seronegative NMOSD cases.
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Welcome to "PICU Doc on Call," the podcast where real cases meet real expertise at the bedside! Join Dr. Monica Gray, Dr. Pradip Kamat, and Dr. Rahul Damania as they unravel the mysteries of pediatric critical care. In today’s episode, our team dives into the compelling case of a previously healthy seven-year-old girl who arrives with seizures, right arm weakness, and sudden respiratory failure. Together, they’ll break down the diagnosis and management of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease, also known as MOGAD. This autoimmune demyelinating disorder can challenge even the most seasoned clinicians.
Tune in as our experts walk you through the clinical features, essential diagnostic workup, and the critical importance of early immunosuppressive therapy. Whether you’re at the bedside or on the go, this episode is packed with practical pearls and a multidisciplinary approach to recognizing and treating acute pediatric neuroimmunological emergencies in the PICU. Let’s get started!
Show Highlights:
Presentation of a complex pediatric case involving a seven-year-old girl with new-onset seizures and acute respiratory failure
Discussion of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) as an autoimmune demyelinating disorder
Overview of the clinical presentation and diagnostic criteria for autoimmune encephalitis
Importance of a broad differential diagnosis, including infectious and autoimmune causes, in pediatric patients with seizures and neurological deficits
Diagnostic approach involving MRI, lumbar puncture, and antibody testing for MOGAD
Management strategies for MOGAD, including stabilization, seizure control, and immunosuppressive therapy
Neurocritical care considerations for monitoring and treating elevated intracranial pressure
Long-term management challenges and the need for multidisciplinary care in pediatric patients with MOGAD
Discussion of potential outcomes and the risk of relapse in children with MOGAD.
Emphasis on the importance of early and comprehensive diagnostic testing to avoid misdiagnosis
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