Initial Clinical and Radiological Phenotype as a Predictor of Long-term Functional Outcome in Pediatric MOGAD: A Rapid Review (2015-2025)

Objective To identify whether initial clinical and radiological phenotype predicts long-term domain-specific functional outcomes in pediatric myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) through a rapid review of evidence from 2015-2025. Background Pediatric MOGAD includes acute disseminated encephalomyelitis (ADEM), optic neuritis (ON), transverse myelitis (TM), and encephalitis, with variable functional trajectories. The presenting phenotype determines the primary outcome domain at risk (cognitive, visual, motor, or autonomic), yet phenotype-based predictors have not been synthesized. Design/Methods A rapid review of PubMed-indexed English-language studies (2015-2025) was conducted. Studies reporting pediatric phenotype-stratified functional outcomes in patients with confirmed MOG-IgG using cell-based assays were included. Adult-only cohorts, non-validated assays, and studies lacking phenotype-stratified pediatric outcomes were excluded. Data were synthesized narratively. Results Fifteen studies, including approximately 590 pediatric patients, were analyzed. ADEM showed the greatest cognitive burden: 39.5% required educational support post-onset versus 8.6% pre-onset (p < 0.05), and it independently predicted academic difficulty (78.9% vs. 41.3%, p = 0.02); deep grey matter involvement occurred in 86.6%. ON showed better visual recovery in children than adults (73.3% vs. 31.0%, p = 0.001) despite similar retinal nerve fiber layer atrophy (∼63 µm) and had the highest relapse rates. TM conferred the highest disability risk: each one-point increase in nadir Expanded Disability Status Scale (EDSS) was associated with a 6.7-fold increase in odds of long-term disability (OR 6.65, 95% CI 1.33-33.26, p = 0.021), with persistent bladder dysfunction in 28%. Encephalitis was associated with higher epilepsy rates (18.2% vs. 1.4%, p = 0.003) and longer time to steroid initiation. Early immunotherapy initiated within 7 days reduced relapse risk significantly (OR 0.15, 95% CI 0.03-0.61, p = 0.009). Conclusions Initial phenotype predicts domain-specific outcomes in pediatric MOGAD: ADEM (cognitive), ON (visual), TM (motor/autonomic), and encephalitis (epilepsy). Early immunotherapy is the key modifiable predictor. Standardized phenotype-based outcome assessment is warranted regardless of initial presentation.