2026 American Academy of Neurology Abstract Website

Giacomo Greco¹, Stefano Masciocchi¹, Pietro Businaro¹, Federica Zuliani¹, Margherita Vacca¹, Chiara Morandi¹, Eleonora Rigoni¹, Giorgia Bruno², Sara Carta³, Mario Risi², Manuela Lo Bianco⁴, Antonio Covelli⁵, Giulia Cellante⁶, Silvia Sperandei⁸, Alessandro Santagostino Barbone⁹, Thomas Foiadelli¹⁰, Alvino Bisecco¹¹, Erica Curti¹², Emanuela Claudia Turco¹³, Antonio Gallo¹¹, Chiara Rocchi¹⁴, Saif Huda¹⁴, Margherita Mancardi⁹, Massimiliano Di Filippo⁸, Martina Fabris⁶, Alberto Vogrig⁷, Simone Vidale⁵, Martino Ruggieri⁴, Antonio Varone², Sara Mariotto³, Georgina Arrambide¹⁵, Alvaro Cobo Calvo¹⁵, Romain Marignier¹⁶, Elena Colombo¹, Matteo Gastaldi¹
¹IRCCS Mondino Foundation, ²Paediatric Neurology Unit, Department of Neurosciences, Santobono-Pausilipon Children’s Hospital, ³Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, ⁴Unit of Paediatric Clinic, Department of Clinical and Experimental Medicine, University of Catania, ⁵Neurology and Stroke Unit, ASST SetteLaghi, Ospedale di Circolo/Fondazione Macchi, ⁶Department of Medicine (DMED), University of Udine, ⁷University of Udine, ⁸Section of Neurology, Department of Medicine, University of Perugia, ⁹Department of Neuroscience, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences, University of Genova, ¹⁰Clinica Pediatrica, Fondazione IRCCS Policlinico San Matteo, University of Pavia, ¹¹Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", ¹²Multiple Sclerosis Centre, Neurology Unit, Department of General Medicine, ¹³Child Neuropsychiatric Unit, Maternal and Child Health Department, Parma University Hospital, ¹⁴Walton Centre NHS Foundation Trust, ¹⁵Cemcat, Vall d´Hebron University Hospital, ¹⁶Lyon University Hospital

Objective:

We aimed to assess the potential of Proteolipid Protein 1 (PLP1)-IgG as a prognostic biomarker in a large multicentric MOGAD cohort.

Background:

Conformational antibodies to PLP1 have been found in a subset of MOGAD patients, who present with a more aggressive disease onset.

Design/Methods:

We included 127 consecutive MOGAD patients from 13 centres, with serum samples available within three months of disease diagnosis and a 12 month-minimum follow-up. PLP1-IgG were assessed with an in-house live cell-based assay and reported as positive with a 1:40 titre. Demographical, clinical, paraclinical features and disability outcomes were compared among PLP1+ and PLP1- MOGAD patients. Incomplete recovery from the presenting attack was defined as an mRS or EDSS ≥ 2 at discharge after acute phase treatment. Multivariate logistic regression was performed to identify independent predictors of incomplete recovery. Time to first relapse was analyzed using Cox proportional hazards regression with serostatus stratification.

Results:

PLP1-IgG were found in 16% of patients (20/127), more frequently within adults rather than children (23% vs 10%). Despite similar clinical severity at disease acme (EDSS and mRS: p=0.92; p=0.86), PLP1+ MOGAD patients showed a higher rate of incomplete inaugural attack recovery (12/20 vs. 32/107, p<0.001). Disability measures at discharge were significantly higher in PLP1+ patients (median EDSS 2.0 vs 1.0, p<0.01; median mRS 1.0 vs 0.0, p<0.001)
PLP1 positivity was the only significant predictor of incomplete recovery in the multivariate logistic regression model (OR 3.89 [CI 1.36 – 11.76]), whereas motor symptoms, baseline EDSS, and mRS showed no significant association. PLP1+ MOGAD patients had a significantly shorter time to first relapse compared to PLP1– (Cox Hazard Ratio 2.44 [CI 1.11 – 5.35], p=0.026).

Conclusions:

PLP1 antibodies identify a high-risk subgroup of MOGAD patients with residual disability after the first attack and a higher predisposition to a relapsing course.